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Widely differing screening and treatment practice for osteoporosis in patients with inflammatory bowel diseases in the Swiss IBD cohort study.

Abstract Low bone mineral density (BMD) and osteoporosis remain frequent problems in patients with inflammatory bowel diseases (IBDs). Several guidelines with nonidentical recommendations exist and there is no general agreement regarding the optimal approach for osteoporosis screening in IBD patients. Clinical practice of osteoporosis screening and treatment remains insufficiently investigated.In the year 2014, a chart review of 877 patients included in the Swiss IBD Cohort study was performed to assess details of osteoporosis diagnostics and treatment. BMD measurements, osteoporosis treatment, and IBD medication were recorded.Our chart review revealed 253 dual-energy x-ray absorptiometry (DXA) scans in 877 IBD patients; osteoporosis was prevalent in 20% of tested patients. We identified widely differing osteoporosis screening rates among centers (11%-62%). A multivariate logistic regression analysis identified predictive factors for screening including steroid usage, long disease duration, and perianal disease; even after correction for all risk factors, the study center remained a strong independent predictor (odds ratio 2.3-21 compared to the center with the lowest screening rate). Treatment rates for patients with osteoporosis were suboptimal (55% for calcium, 65% for vitamin D) at the time of chart review. Similarly, a significant fraction of patients with current steroid medication were not treated with vitamin D or calcium (treatment rates 53% for calcium, 58% for vitamin D). For only 29% of patients with osteoporosis bisphosphonate treatment was started. Treatment rates also differed among centers, generally following screening rates. In patients with longitudinal DXA scans, calcium and vitamin D usage was significantly associated with improvement of BMD over time.Our analysis identified inconsistent usage of osteoporosis screening and underuse of osteoporosis treatment in IBD patients. Increasing awareness of osteoporosis as a significant clinical problem in IBD patients might improve patient care.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28562531
OWN - NLM
STAT- In-Process
DA  - 20170531
LR  - 20170531
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 22
DP  - 2017 Jun
TI  - Widely differing screening and treatment practice for osteoporosis in patients
      with inflammatory bowel diseases in the Swiss IBD cohort study.
PG  - e6788
LID - 10.1097/MD.0000000000006788 [doi]
AB  - Low bone mineral density (BMD) and osteoporosis remain frequent problems in
      patients with inflammatory bowel diseases (IBDs). Several guidelines with
      nonidentical recommendations exist and there is no general agreement regarding
      the optimal approach for osteoporosis screening in IBD patients. Clinical
      practice of osteoporosis screening and treatment remains insufficiently
      investigated.In the year 2014, a chart review of 877 patients included in the
      Swiss IBD Cohort study was performed to assess details of osteoporosis
      diagnostics and treatment. BMD measurements, osteoporosis treatment, and IBD
      medication were recorded.Our chart review revealed 253 dual-energy x-ray
      absorptiometry (DXA) scans in 877 IBD patients; osteoporosis was prevalent in 20%
      of tested patients. We identified widely differing osteoporosis screening rates
      among centers (11%-62%). A multivariate logistic regression analysis identified
      predictive factors for screening including steroid usage, long disease duration, 
      and perianal disease; even after correction for all risk factors, the study
      center remained a strong independent predictor (odds ratio 2.3-21 compared to the
      center with the lowest screening rate). Treatment rates for patients with
      osteoporosis were suboptimal (55% for calcium, 65% for vitamin D) at the time of 
      chart review. Similarly, a significant fraction of patients with current steroid 
      medication were not treated with vitamin D or calcium (treatment rates 53% for
      calcium, 58% for vitamin D). For only 29% of patients with osteoporosis
      bisphosphonate treatment was started. Treatment rates also differed among
      centers, generally following screening rates. In patients with longitudinal DXA
      scans, calcium and vitamin D usage was significantly associated with improvement 
      of BMD over time.Our analysis identified inconsistent usage of osteoporosis
      screening and underuse of osteoporosis treatment in IBD patients. Increasing
      awareness of osteoporosis as a significant clinical problem in IBD patients might
      improve patient care.
FAU - Schule, Solvey
AU  - Schule S
AD  - aDivision of Gastroenterology and Hepatology, University Hospital Zurich and
      University of Zurich, Zurich bInstitute of Social and Preventive Medicine,
      Lausanne University Hospital, Lausanne cDivision of Rheumatology, University
      Hospital Zurich and University of Zurich dDepartment of Medicine, Division of
      Gastroenterology, Triemli Hospital, Zurich, Switzerland.
FAU - Rossel, Jean-Benoit
AU  - Rossel JB
FAU - Frey, Diana
AU  - Frey D
FAU - Biedermann, Luc
AU  - Biedermann L
FAU - Scharl, Michael
AU  - Scharl M
FAU - Zeitz, Jonas
AU  - Zeitz J
FAU - Freitas-Queiroz, Natalia
AU  - Freitas-Queiroz N
FAU - Kuntzen, Thomas
AU  - Kuntzen T
FAU - Greuter, Thomas
AU  - Greuter T
FAU - Vavricka, Stephan R
AU  - Vavricka SR
FAU - Rogler, Gerhard
AU  - Rogler G
FAU - Misselwitz, Benjamin
AU  - Misselwitz B
CN  - Swiss IBD cohort study
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/06/01 06:00
MHDA- 2017/06/01 06:00
CRDT- 2017/06/01 06:00
AID - 10.1097/MD.0000000000006788 [doi]
AID - 00005792-201706020-00007 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jun;96(22):e6788. doi: 10.1097/MD.0000000000006788.

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