Bone Health & IBD

Reduced bone density is common in IBD and affects around 30-60% of people (1).

Some people with Crohn’s and Colitis may have osteoporosis, which literally means porous bones and is sometimes called brittle bones. Other bone abnormalities that people with IBD can have are osteopenia, which is low bone density, and osteomalacia which is softening of the bones.

Bone issues may be more common in people with Crohn’s Disease compared to UC and they are also more common in women (2).

Even though our bones are very solid, they are actually also living tissues. Our body is continuously removing old bone (bone resorption) and building new bone (bone formation) in a processed of called bone remodelling.

 

What causes bone loss in IBD?

Bone issues in people with IBD can happen for a number of reasons, the majority of which I have listed below – these can happen all together or individually to impact our bone health in IBD (2):

  • Steroid treatment – steroids can impact bone health in a number of ways including decreasing calcium absorption in the intestine and increasing calcium excretion in urine.

  • Inflammation – this can disrupt bone remodelling.

  • Problems absorbing important minerals like calcium

  • Vitamin D deficiency – vitamin D helps to regulate calcium levels in our bodies and it vital for building healthy bones. Vitamin D deficiency is common in IBD (you can read more about vitamin D here).

  • Decreased physical activity – physical activity is important to help keep our bones strong but if we don’t feel well or we worry about leaving the house then our levels of physical activity can decrease.

 

Risk factors for bone loss in IBD

There are some factors that may put someone with IBD at greater risk of bone issues. These include long term steroid use, smoking, high alcohol consumption, female sex, low BMI, and increasing age.  

Symptoms and Diagnosis

Osteomalacia may cause some bone or muscle pain but generally there are few symptoms of osteopenia and osteoporosis. Often, people only discover they have these issues when they break or fracture a bone and it is revealed on a scan.

Bone loss can be diagnosed using special x-ray technology called dual-energy X-ray absorptiometry (DEXA). Results of the test, which measure bone mineral density in the spine, hip, and other bones, indicate the persons risk of suffering a bone fracture. In the general population, a diagnosis of osteopenia (weak bones) doubles the risk of fracture, and a diagnosis of osteoporosis increases the risk by four or five times as the bones are less dense and weaker, and therefore more at risk of breaking (1).

Supporting Bone Health in IBD

  1. Eat foods containing calcium daily – dairy and dairy containing foods like yoghurt (lactose free if you are lactose intolerant), or fortified dairy milk alternatives (check labelling), fish (especially those with edible bones but careful with strictures here), clams, oysters, green vegetables, kelp, pulses, nuts, wholegrains (although vegetable and cereal sources have lower bioavailability). If you have a diet low in calcium containing foods it could be helpful to take a calcium supplement but please ask your doctor or nutritionist before doing so.

  2. Ensure you have enough vitamin D – sun exposure is the best way to get vitamin D. Vitamin D can be found in fortified milks, fish and eggs but this is usually not enough to sustain levels on their own. During the winter months the NHS recommends everyone take a vitamin D supplement. Vitamin D deficiency is common in IBD and you can ask your doctor to check for a deficiency if you are worried next time you have a blood test.

  3. Stop smoking - you can read more about smoking at IBD here.

  4. Reduce alcohol - you can read more about alcohol at IBD here

  5. Ensuring regular physical activity – this can be at home movement if you are unable to leave the house like walking up and down stairs and gentle weight training (bodyweight or weighted).

  6. Steroids – if you are taking steroids speak with your doctor about support for your bone health. In the UK, AdCal and other preparations are available on prescription to take whilst you are on steroids.

 

References

  1. Crohns and Coltiis Foundation (2015) Bone Loss. available from: https://www.crohnscolitisfoundation.org/sites/default/files/2020-03/boneloss.pdf Accessed: 08 March 2021

  2. Sgambato, D., Gimigliano, F., De Musis, C., Moretti, A., Toro, G., Ferrante, E., Miranda, A., De Mauro, D., Romano, L., Iolascon, G., & Romano, M. (2019). Bone alterations in inflammatory bowel diseases. World journal of clinical cases, 7(15), 1908–1925. https://doi.org/10.12998/wjcc.v7.i15.1908

Clemmie Macpherson