Osteoporosis is a disease that weakens bones — and people living with an inflammatory bowel disease (IBD), including Crohn’s disease, are more likely than others to develop it. A study published in March 2006 in the journal Digestion found that almost 50 percent of people with IBDs are affected by osteoporosis or osteopenia, a condition that is often considered the precursor to osteoporosis.
Osteoporosis is an especially dangerous disorder because often you don't notice any signs until you break a bone. If you have Crohn's disease, knowing that you're at increased risk for osteoporosis can be beneficial in two ways: You can keep an eye out for possible osteoporosis symptoms, and you can take action before the condition progresses too far.
Treatments for IBDs Could Be Risk Factors for Osteoporosis
Research has found that some treatments commonly recommended for IBDs — including corticosteroids, a type of medication, and bowel resection, a surgical procedure — could be risk factors for osteoporosis. Here's why:
Corticosteroids These are a type of steroid often used to bring an acute attack of Crohn’s disease into remission. While effective, these drugs also comes with a long list of possible side effects, including a tendency to decrease the number of bone-forming cells in the body and increase the amount of calcium excreted through the urine. According to the Crohn's and Colitis Foundation of America (CCFA), 30 to 50 percent of people who take corticosteroids on a long-term basis are thought to develops osteoporosis. The impact on bone heath depends on both medication dose and length of time on the drug.
If you take corticosteroids to manage Crohn’s disease, your doctor may prescribe both calcium and vitamin D supplements to help offset these side effects. Other prescription drugs known as bisphosphonates have also been successful at reducing the risk of osteoporosis caused by corticosteroids, and are often prescribed for Crohn’s patients.
Bowel Resection For some people with Crohn’s, surgery is a good treatment option. Bowel resection is a surgery that's performedwhenCrohn’s disease affects a long section of intestine. During this procedure, the diseased portion of the intestine is removed, and the healthy areas are reconnected.
The problem is that the removed bowel sections can be sites of absorption for many important nutrients, including some that are needed for bone health.
“If the part of your intestine that absorbs vitamin D and calcium is affected by Crohn’s disease, that can increase your risk of osteoporosis,” says Miguel Regueiro, MD, gastroenterologist at the University of Pittsburgh Medical Center Presbyterian and IBD clinical director for the department of medicine at the University of Pittsburgh.
Crohn’s Disease and Bone Density
It’s not just the treatments for Crohn’s disease that can cause bone health problems; Crohn’s disease itself may weaken bones. Proteins secreted by the immune system called cytokines that are involved in the disease process of Crohn’s may also play some role in bone thinning, explains Dr. Regueiro. These cytokines ignite the immune system against the bowel, and in doing so may also weaken bones. According to the CCFA, as many as 30 to 60 percent of people with Crohn’s disease or ulcerative colitis have lower-than-average bone density.
Although scientists are not certain exactly how the cytokines in Crohn’s disease affect bones, there's increasing evidence to suggest a direct link between Crohn’s disease and bone thinning, independent of treatment side effects.
This means that whether or not corticosteroids or bowel resection have been a part of your Crohn’s disease treatment plan, it’s a good idea to talk to your doctor about the risk of osteoporosis.
Ways to Help Prevent Osteoporosis if You Have Crohn’s Disease
If you have Crohn’s disease, your doctor can help you minimize risk factors for osteoporosis in several ways. These include:
- Regular Testing Your doctor may start regularly checking your bone health with standard tests for osteoporosis, including ultrasounds or DEXA scans (dual energy X-ray absorptiometry). Keeping a close eye on the strength of your bones will help your doctor tailor the best treatment plan for you.
- Getting a Medication “Tune-Up” So you’re on steroids and you feel doomed to a life of thin bones? This doesn't necessarily have to be the case. Ask your doctor about limiting bone-weakening drugs — like steroids — in favor of a variety of other options that don’t have negative effects on your bones. Some of these alternative drugs include Imuran (azathioprine), Trexall (methotrexate), and Remicade (infliximab).
- Supplements Vitamin D and calcium are important ingredients for optimal bone health, and having too little of either puts you at risk for weak bones. Talk to your doctor to see if it makes sense for you to start taking vitamin D or calcium supplements. The general recommendations are 1,500 milligrams of calcium and 800 international units of vitamin D each day, so depending on how much you get now, you may or may not want to add a supplement.
- Bone-Strengthening Medication If you're taking steroids on a continuous basis, your doctor may prescribe bisphosphonates like Actonel (risedronate) and Fosamax (alendronate) to help keep your bones strong.
- Exercise Keeping physically active is an important aspect of living your best life in general, and weight-bearing exercise in particular is important for bone health. These include high-impact activities like dancing, hiking, jogging, and aerobics, which force bones to work harder and strengthens them in the process. And for those that can’t (or don’t want to) engage in high-impact activities, low-impact exercises that require weight bearing like walking, low-impact aerobics, and stair-stepping machines are great choices, too.
- Other Lifestyle Changes Not smoking and limiting your alcohol intake are other steps you can take to help keep your bones strong.
The Bottom Line: Talk to your doctor about your bone health if you have Crohn’s disease. If you've been prescribed supplements, take them regularly. And get your doctor’s approval before launching a new exercise routine. Once you've been given the okay, keep at it. In following the tips outlined here, you can take the necessary steps toward enjoying a lifetime of strong bones.