Crohn’s disease is an inflammatory bowel disease (IBD) usually occurring in the lower part of the small intestine (ileum), although it can affect any part of the digestive tract. The inflammation penetrates the lining of the affected organ or area causing significant pain, discomfort, and diarrhea.
Osteoporosis causes bones to lose density and become more prone to fractures. It can be accompanied by pain and disability. This disease afflicts an estimated 44 million Americans, of whom 68% are women.
Crohn’s is linked to a greater risk of developing bone related issues. Studies show that about 30 to 60% of patients with Crohn’s and ulcerative colitis (another IBD) have osteopenia (low bone density but not as severe as osteoporosis), osteoporosis, or osteomalacia (softening bones).
General Risk Factors for Osteoporosis
Experts consider increasing age, female gender, and low body mass index (BMI) as major risk factors for osteoporosis.
Other risk factors include:
- Post-menopausal status
- History of fracture
- Alcohol consumption
- Family history of osteoporosis
The Link Between Crohn’s Disease and Osteoporosis
People with Crohn’s disease are particularly susceptible to developing osteoporosis. The risk of bone fracture is at least 40% higher than in healthy people of the same age and gender.
A number of factors relate Crohn’s disease to osteoporosis:
1. Bone Metabolism: In a healthy body, bone metabolism (breaking down and rebuilding) proceeds in a balanced manner and bones stay strong. In Crohn’s, inflammation in the bowels causes changes in bone metabolism and other body processes. Osteoclasts—cells that break down bone—become overactive, while osteoblasts—the “bone-building” cells—cannot cope, resulting in weaker bones.
2. Active Inflammation: IBD patients have high concentrations of proteins called cytokines, which increase the body’s inflammatory response. These chemicals disrupt normal bone metabolism. Individuals with active Crohn’s have greater cytokine activity and are at greater risk of developing osteoporosis. Cytokines lower bone mass density.
3. Diet or Malabsorption: Inability to absorb nutrients from food can contribute to weaker bones. People with IBD typically eat fewer calcium and vitamin D rich foods. Both are essential for bone health. Also, Crohn’s disease patients with advanced small bowel disease or who have undergone a surgical removal of their small bowel are sometimes unable to absorb necessary fat. This includes fat-soluble vitamins like vitamin D.
4. Corticosteroid Therapy: Often used to treat IBD, corticosteroids are strongly linked with osteoporosis. These medications impair the formation of new bone by:
- blocking osteoblasts and increasing the activity of osteoclasts, resulting in accelerated bone loss;
- decreasing the amount of calcium in the bones and increasing its excretion into the urine; and
- reducing the production of the hormone estrogen, which contributes to strong bones.
Between 25% and 50% of people on long-term corticosteroids run the risk of bone fracture.
5. Low Physical Activity: Low levels of exercise have been linked with IBD. Weight-bearing exercise contributes to bone strength.
6. Vitamin D: Critical for the absorption of calcium, vitamin D is absorbed in the small intestine. People with Crohn’s disease, especially those who have undergone small bowel surgery, are at increased risk for vitamin D deficiency. This can be responsible for bone loss, causing both reduced calcium absorption and poor bone mineralization. Inadequate sun exposure can also deprive the body of vitamin D as sunlight is needed to synthesize vitamin D in the skin.
Strategies for preventing or at least reducing the risk of osteoporosis in people with Crohn’s disease include a combination of good nutrition, exercise, a healthy lifestyle, and sometimes medication. It takes time and attention, working closely with your healthcare provider, to formulate the best long-term treatment possible.
To learn more about Crohn’s disease, osteoporosis, and your treatment options, call Rockville Concierge Doctors and schedule a complimentary consultation today. Call (301) 545-1811 or get started online.