Increased incidence of "fragility" fractures in patients with inflammatory bowel disease

increased risk was similar in patients with Crohn's disease (CD) and ulcerative colitis (UC). These results differ from a large Danish case control study which reported a 2.5-fold increase in the risk of fracture among women with CD but failed to demonstrate a statistically significant increased risk among men with CD or patients with UC. 3 The litera- ture on BMD in IBD is also discordant when comparing the risk of osteoporosis in patients with CD with those with UC. 1 Further large studies of fracture in these disorders are required to quantify the risk in CD and UC. The reduction in BMD in patients with IBD is multifactorial;risk factors include the use of oral corticosteroids, vitamin D deficiency, malabsorption, malnutrition, hypogonadism, and systemic inflamma- tion. The use of oral corticosteroids increases the risk of fracture at most sites across a range of diseases. 4 In IBD, continuous, but not intermittent, use is associated with a significant reduction in Results: Patients with IBD had a significantly increased incidence of fractures at the spine (incidence rate ratio (IRR) 1.74 (95% confidence interval (CI) 1.34-2.24); p<0.001), hip (IRR 1.59 (95% CI 1.27-2.00); p<0.001), wrist/forearm (IRR 1.33 (95% CI 1.11-1.58); p=0.001), and rib (IRR 1.25 (95% CI 1.02-1.52); p=0.03), and of any of these fractures (IRR 1.41 (95% CI 1.27- 1.56); p<0.001). Patients with ulcerative colitis had similar fracture rates to those with Crohn's disease. Conclusion: The incidence of these fractures among those with IBD was 40% greater than that in the general population.