Bone Loss Prevention of Bisphosphonates in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Objective The purpose of this study was to evaluate the effect of bisphosphonates in improving bone mineral density (BMD) and decreasing the occurrence rate of fractures and adverse events in patients with inflammatory bowel disease (IBD). Methods Randomized controlled trials (RCTs) which use bisphosphonates in IBD patients were identified in PubMed, MEDLINE database, EMBASE database, Web of Knowledge, and the Cochrane Databases between 1990 and June 2016. People received bisphosphonate or placebos with a follow-up of at least one year were also considered. STATA 12.0 software was used for the meta-analysis. Results Eleven randomized clinical trials were included in the meta-analysis. The data indicated that the percentage change in the increased BMD in the bisphosphonates groups was superior to that of the control groups at the lumbar spine and total hip. At the femoral neck, there was no significant difference between the two groups. The incidence of new fractures during follow-up showed significant reduction. The adverse event analysis revealed no significant difference between the two groups. Conclusion Our results demonstrate that bisphosphonates therapy has an effect on bone loss in patients with IBD but show no evident efficiency at increasing the incidence of adverse events.

[1]  C. O'Morain,et al.  A 1-year prospective study of the effect of infliximab on bone metabolism in inflammatory bowel disease patients , 2016, European journal of gastroenterology & hepatology.

[2]  A. Lyra,et al.  Risk factors for osteoporosis in inflammatory bowel disease patients. , 2015, World journal of gastrointestinal pathophysiology.

[3]  Jiyeon Yu,et al.  Bone Loss Triggered by the Cytokine Network in Inflammatory Autoimmune Diseases , 2015, Journal of immunology research.

[4]  P. Lips,et al.  Treatment of bone loss in osteopenic patients with Crohn's disease: a double-blind, randomised trial of oral risedronate 35 mg once weekly or placebo, concomitant with calcium and vitamin D supplementation , 2013, Gut.

[5]  J. Payer,et al.  The prevalence and risk factors for osteoporosis in patients with inflammatory bowel disease. , 2013, Bratislavske lekarske listy.

[6]  R. Fedorak,et al.  Risedronate improves bone mineral density in Crohn's disease: a two year randomized controlled clinical trial. , 2012, Journal of Crohn's & colitis.

[7]  A. Maclennan,et al.  Multiple choice in the management of the menopause , 2011 .

[8]  C. Gordon,et al.  Efficacy and Harms of Nasal Calcitonin in Improving Bone Density in Young Patients With Inflammatory Bowel Disease: A Randomized, Placebo-Controlled, Double-Blind Trial , 2011, The American Journal of Gastroenterology.

[9]  R. Russell,et al.  Bisphosphonates: the first 40 years. , 2011, Bone.

[10]  F. Ghishan,et al.  Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases. , 2011, American journal of physiology. Gastrointestinal and liver physiology.

[11]  G. Adler,et al.  Bones and Crohn's: no benefit of adding sodium fluoride or ibandronate to calcium and vitamin D. , 2011, World journal of gastroenterology.

[12]  P. Lakatos,et al.  Clinical relevance of changes in bone metabolism in inflammatory bowel disease. , 2010, World journal of gastroenterology.

[13]  Stanley B. Cohen,et al.  Once-Weekly Oral Alendronate 70 mg in Patients with Glucocorticoid-Induced Bone Loss: A 12-Month Randomized, Placebo-Controlled Clinical Trial , 2009, The Journal of Rheumatology.

[14]  M. Sata,et al.  Clinical trial: comparison of alendronate and alfacalcidol in glucocorticoid‐associated osteoporosis in patients with ulcerative colitis , 2009, Alimentary pharmacology & therapeutics.

[15]  S. Targan,et al.  Recent advances in IBD pathogenesis: Genetics and immunobiology , 2008, Current gastroenterology reports.

[16]  Yoshiya Tanaka,et al.  Alendronate Protects Premenopausal Women from Bone Loss and Fracture Associated with High-dose Glucocorticoid Therapy , 2008, The Journal of Rheumatology.

[17]  V. Borba,et al.  Níveis baixos de 25-hidroxivitamina D (25OHD) em pacientes com doença inflamatória intestinal e sua correlação com a densidade mineral óssea , 2008 .

[18]  P. Tugwell,et al.  Etidronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. , 2024, The Cochrane database of systematic reviews.

[19]  R. Kitazawa,et al.  Dexamethasone promotes osteoclastogenesis by inhibiting osteoprotegerin through multiple levels , 2008, Journal of cellular biochemistry.

[20]  V. Borba,et al.  [Low levels of 25-hydroxyvitamin D (25OHD) in patients with inflammatory bowel disease and its correlation with bone mineral density]. , 2008, Arquivos brasileiros de endocrinologia e metabologia.

[21]  P. Tugwell,et al.  Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. , 2008, The Cochrane database of systematic reviews.

[22]  P. Tugwell,et al.  Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. , 2008, The Cochrane database of systematic reviews.

[23]  C. Roux,et al.  A double-blind placebo-controlled study of intravenous clodronate for prevention of steroid-induced bone loss in inflammatory bowel disease. , 2007, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[24]  R. Prince,et al.  A Double-Blind Placebo-Controlled Study of the Effects of the Bisphosphonate Risedronate on Bone Mass in Patients with Inflammatory Bowel Disease , 2006, The American Journal of Gastroenterology.

[25]  F. Manguso,et al.  Efficacy of risedronate administration in osteoporotic postmenopausal women affected by inflammatory bowel disease , 2005, Osteoporosis International.

[26]  H. Steinhart,et al.  Randomized trial of etidronate plus calcium and vitamin D for treatment of low bone mineral density in Crohn's disease. , 2005, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[27]  A. Ho,et al.  The efficacy and tolerability of risedronate on bone mineral density and bone turnover markers in osteoporotic Chinese women: a randomized placebo-controlled study. , 2005, Bone.

[28]  B. Ryan,et al.  Effect of antitumour necrosis factor‐α therapy on bone turnover in patients with active Crohn's disease: a prospective study , 2004, Alimentary pharmacology & therapeutics.

[29]  R. Hubbard,et al.  Hip fractures in patients with inflammatory bowel disease and their relationship to corticosteroid use: a population based cohort study , 2004, Gut.

[30]  D. Rawlings,et al.  A randomized controlled trial of calcium with vitamin D, alone or in combination with intravenous pamidronate, for the treatment of low bone mineral density associated with Crohn's disease , 2003, Alimentary pharmacology & therapeutics.

[31]  W. Kratzer,et al.  Therapy of osteoporosis in patients with Crohn's disease: a randomized study comparing sodium fluoride and ibandronate , 2003, Alimentary pharmacology & therapeutics.

[32]  C. Bernstein,et al.  The Incidence of Fracture among Patients with Inflammatory Bowel Disease: A Population-Based Cohort Study , 2000, Annals of Internal Medicine.

[33]  S. Cummings,et al.  Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. , 2000, The Journal of clinical endocrinology and metabolism.

[34]  M. Staun,et al.  Alendronate increases lumbar spine bone mineral density in patients with Crohn's disease. , 2000, Gastroenterology.

[35]  A. Rieber,et al.  Increase of bone mineral density with sodium fluoride in patients with Crohn's disease , 1998, European journal of gastroenterology & hepatology.

[36]  W. Fries,et al.  Evolution of osteopenia in inflammatory bowel disease , 1999, American Journal of Gastroenterology.

[37]  K. Mann,et al.  Reduced Bone Mineral Density and Unbalanced Bone Metabolism in Patients with Inflammatory Bowel Disease , 1998, Inflammatory bowel diseases.