High-resolution Quantitative Computed Tomography Demonstrates Structural Defects in Cortical and Trabecular Bone in IBD Patients

J Crohns Colitis. 2016 May;10(5):532-40. doi: 10.1093/ecco-jcc/jjw012. Epub 2016 Jan 27.


Background and aims: To investigate the macro- and microstructural changes of bone in patients with inflammatory bowel disease [IBD] and to define the factors associated with bone loss in IBD.

Methods: A total of 148 subjects, 59 with Crohn's disease [CD], 39 with ulcerative colitis [UC], and 50 healthy controls were assessed for the geometric, volumetric and microstructural properties of bone using high-resolution peripheral quantitative computed tomography. In addition, demographic and disease-specific characteristics of IBD patients were recorded.

Results: IBD patients and controls were comparable in age, sex, and body mass index. Total [p = 0.001], cortical [p < 0.001], and trabecular volumetric bone mineral density [BMD] [p = 0.03] were significantly reduced in IBD patients compared with healthy controls. Geometric and microstructural analysis revealed significantly lower cortical area [p = 0.001] and cortical thickness [p < 0.001] without differences in cortical porosity, pore volume, or pore diameter. CD showed a more severe bone phenotype than UC: cortical bone loss was observed in both diseases, but CD additionally showed profound trabecular bone loss with reduced trabecular BMD [p = 0.008], bone volume [p = 0.008], and trabecular thickness [p = 0.009]. Multivariate regression models identified the diagnosis of CD, female sex, lower body mass index, and the lack of remission as factors independently associated with bone loss in IBD.

Conclusion: IBD patients develop significant cortical bone loss, impairing bone strength. Trabecular bone loss is limited to CD patients, who exhibit a more severe bone phenotype compared with UC patients.

Keywords: Inflammatory bowel disease; bone; computed tomography; osteoporosis.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Cancellous Bone / diagnostic imaging*
  • Cancellous Bone / pathology
  • Case-Control Studies
  • Colitis, Ulcerative / complications*
  • Colitis, Ulcerative / pathology
  • Cortical Bone / diagnostic imaging*
  • Cortical Bone / pathology
  • Crohn Disease / complications*
  • Crohn Disease / pathology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Osteoporosis / diagnostic imaging*
  • Osteoporosis / etiology
  • Osteoporosis / pathology
  • Prospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed* / methods