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J Clin Densitom. 2018 Aug 13. pii: S1094-6950(18)30073-8. doi: 10.1016/j.jocd.2018.07.010. [Epub ahead of print]

Does the Antitumor Necrosis Factor-α Therapy Decrease the Vertebral Fractures Occurrence in Inflammatory Bowel Disease?

Author information

1
Department of Gastroenterology, University Hospital Virgen Macarena, Seville, Spain. Electronic address: bmalpe@hotmail.com.
2
Department of Gastroenterology, University Hospital Virgen Macarena, Seville, Spain.
3
Department of Gastroenterology, University Hospital Virgen Macarena, Seville, Spain; Medicine Department, University of Seville, Seville, Spain.
4
Medicine Department, University of Seville, Seville, Spain; Bone Metabolism Unit, University Hospital Virgen Macarena, Seville, Spain.

Abstract

BACKGROUND/OBJECTIVE:

Osteoporosis and osteoporotic fracture risk are extraintestinal manifestations of the inflammatory bowel disease, whose etiopathogenic mechanisms have not been determined yet. Anti-tumor necrosis factor (TNF)-α are used in treatment of inflammatory bowel disease (IBD), but it is unknown if they play a role in osteoporotic fracture prevention. The objective of this study was to know if anti-TNF decreases fracture risk or modifies bone mineral density. To determine the possible risk factors associated with fractures, and assess the incidence of vertebral fractures in IBD patients.

METHODS:

Longitudinal prospective cohort study (7 yr of follow-up); which included 71 IBD patients, 23 received anti-TNF-α; the remaining 48 received conventional treatment, constituted the control group. Patients participated in a questionnaire which gathered risk factors associated with the development of osteoporosis and fractures. Radiographs of the dorsolumbar-spine were performed and also a bone density measurement. Their biochemical and bone remodeling parameters were determined.

RESULTS:

Although patients who did not receive anti-TNF-α, suffered more fractures but biologic therapy did not reduce the risk of new vertebral fractures. The increase of bone mass was significantly higher the group treated with anti-TNF-α. The increase in the lumbar spine was of 8% and in the femoral neck was of 6.7%. The only determinant factor for the incidence of vertebral fractures was a history of previous fractures (odds ratio of 12.8; confidence interval 95% 2.37-69.9; p = 0.003). The incidence of vertebral fractures in IBD patients was considerably high: 26.7/700 patient-yr.

CONCLUSIONS:

Anti-TNF-α, although increased bone mass in these patients, did not reduce the risk of new vertebral fractures. In this study, patients with IBD have a considerably high incidence of fractures. Only the existence of previous vertebral fractures was a predictive factor for consistent fractures.

KEYWORDS:

Vertebral fractures; anti-TNF-α therapy; bone mineral density; bone remodeling; inflammatory bowel disease

PMID:
30205986
DOI:
10.1016/j.jocd.2018.07.010

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