Crohn’s and Bones: Avoid Osteoporosis Risk

Advice about preventative vitamin supplements

If you have Crohn’s disease, you are more at risk for low bone mineral density, or osteoporosis. This means your chance of breaking your bones is much greater. The good news is there are ways to prevent this, including simple vitamin and mineral supplements. But first, your doctor needs to determine if these are right for you.

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How is osteoporosis related to Crohn’s disease?

Osteoporosis is a common problem in the United States and usually is associated with older age. People with Crohn’s disease, an inflammatory bowel disease characterized by ulcers in the large and small bowel, are particularly susceptible to developing osteoporosis. The chances are as high as 77 percent.

One of the dreaded consequences of osteoporosis is bone fracture, even with minor trauma. The bone fracture risk in Crohn’s disease patients is at least 40 percent higher than in other, unaffected people of the same age and sex.

“People with Crohn’s disease are particularly susceptible to developing osteoporosis. The chances are as high as 77 percent.”

Bret Lashner, MD

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Director of the Center for Inflammatory Bowel Disease

This is why it is important to find ways for Crohn’s disease patients to address their risk of developing osteoporosis.

Test your bone density

If you have Crohn’s, it may be important to test your bone mineral density.

The American College of Gastroenterology and the American Gastroenterological Association guidelines recommend testing in Crohn’s disease patients with at least one of these risk factors:

  • Post-menopausal state
  • Over 60 years old
  • Ongoing treatment with steroids
  • Cumulative prior use of steroids for at least three months
  • History of low-trauma fracture

Bone mineral density can be easily measured with an accurate, painless test called a dual energy X-ray absorptiometry (DEXA) test.

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Other risk factors

There are other risk factors for osteoporosis important to Crohn’s disease patients that aren’t mentioned in the guidelines, including:

  • Cigarette smoking – Crohn’s disease patients have cigarette smoking rates that are much higher than the general population.
  • Active inflammation – The chemicals involved in active inflammation, called cytokines, lower bone mass density.
  • Fat malabsorption – Crohn’s disease patients who have extensive small bowel disease or who have had surgical resection of some of their small bowel may not be able to absorb fat from their diet – including fat-soluble vitamins like vitamin D.
  • Low body mass index (BMI) – Many patients with Crohn’s disease are underweight.

What I recommend: simple supplements

I recommend calcium (1 to 1.5 grams daily) and vitamin D (800 units daily) to my Crohn’s disease patients with one or more of the risk factors I mention above.

You can get these calcium/vitamin D supplements over the counter. Talk to your doctor about taking them along with a multivitamin pill daily. (Those with abnormal DEXA scans will need additional therapies.)

So, sticks and stones will not break your bones, if you work with your doctor to prevent the low bone mineral density often seen in Crohn’s disease patients.

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Bret Lashner, MD

Bret Lashner, MD, is a gastroenterologist, Director of the Center for Inflammatory Bowel Disease and a Professor of Medicine at Cleveland Clinic.
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