Bone Fractures in Patients with Inflammatory Bowel Disease

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The summary below is from the full report titled "The Incidence of Fracture among Patients with Inflammatory Bowel Disease. A Population-Based Cohort Study." It is in the 21 November 2000 issue of Annals of Internal Medicine (volume 133, pages 795-799). The authors are CN Bernstein, JF Blanchard, W Leslie, A Wajda, and BN Yu.

What is the problem and what is known about it so far?

Inflammatory bowel disease is an illness that involves inflammation (swelling and irritation) of the lining of the digestive tract. There are two types of inflammatory bowel disease: Crohn disease and ulcerative colitis. Crohn disease can affect any part of the digestive tract, while ulcerative colitis affects only the large intestine. People with inflammatory bowel disease can become very ill with abdominal pain and diarrhea. They often have difficulty eating and can become undernourished. One of the health consequences of inflammatory bowel disease is osteopenia and osteoporosis. Osteopenia means that bones become less dense. When this bone thinning becomes severe, it is called osteoporosis. Persons with osteoporosis are at high risk for broken bones. However, little is known about whether persons with inflammatory bowel disease experience more bone fractures than do people without this disease.

Why did the researchers do this particular study?

To find out whether people with inflammatory disease have more bone fractures than do people without this disease.

Who was studied?

Using a large computerized database, the researchers identified all 6027 patients with Crohn disease or ulcerative colitis who received health care services through the public insurance system in Manitoba, Canada. For every person with inflammatory bowel disease, the researchers also selected 10 people without the disease from the database; these people were born in the same year, were the same sex, and lived in the same postal area as the person with disease. This resulted in a control group of 60,270 people without inflammatory bowel disease.

How was the study done?

The researchers collected information from the database between 1984 and 1997 on the people with inflammatory disease and the control group. They examined people who went to the doctor or were hospitalized for bone fractures in each group and compared the frequency of fractures in the two groups.

What did the researchers find?

Compared with people without inflammatory bowel disease, people with this disease were 40% more likely to experience a bone fracture. Rates were higher for hip, spine, forearm, and rib fractures.

What were the limitations of the study?

The researchers used a computerized database of doctor visits and hospitalizations, so the study did not directly verify the occurrence of fractures.

What are the implications of the study?

Bone fractures are more common in people with inflammatory bowel disease than they are in people without this disease. Doctors who care for patients with inflammatory bowel disease should be aware of this potential consequence of the disease.