Introduction: Osteoporosis is known chronic complication of inflammatory bowel diseases (IBD). It is known that areal bone mineral density (aBMD) does not sufficiently reflect bone strength and quality. The trabecular bone score (TBS) provides an indirect measurement of bone microarchitecture, independent of aBMD.
Aims and methods: The aim was to assess TBS in IBD patients with regard to disease behavior using in comparison with lumbar spine (LS) BMD. The cohort consisted of 84 IBD patients, 53 with Crohns disease (CD) and 31 with ulcerative colitis (UC). Clinical characteristics i.e. age, gender, anthropometry, clinical behaviour, medication were recorded. The BMD was determined by dual-energy X-ray absorptiometry (DXA, Hologic Discovery) at the lumbar spine. TBS was determined by TBS Insight software (Medimaps, France).
Results: Cohort mean age was 42±14.2 years with the average disease duration of 11±7 years. 12/84 (14%) of the cohort were postmenopausal women. 39.6% (21/53) of CD patients had prior resection of the ileum. At the time of assessment 8/84 (9.5%) of the IBD patients (3CD vs 5 UC patients) were on glucocorticoid therapy with >5 mg equivalent to prednisolone daily. The percentage of patients with substitution of vitamin D (800IU) and calcium (0.51 g) was similar between CD and UC (24.5% vs 29%), none of the patients were on antiporothic treatment. The average LS BMD was 0.964±0.113 g/cm2 and TBS 1.36±0.14. Significantly lower TBS although not LS BMD was found in patients with fistulising CD as compared to those with luminal disease (P=0.0039). We did not observe any difference in TBS or BMD in UC patients according to the disease behaviour.
Conclusion: We observed that spine TBS can identify quality of bone mineral density in patients with Crohns disease better than BMD itself. CD patients with severe disease are at higher risk of low bone mineral density.