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Bisphosphonate reduce the risk of vertebral fractures in low bone mineral density patients with IBD

A study in the latest issue of the Clinical Gastroenterology & Hepatology examines the efficacy and safety of medical therapy for low bone mineral density in patients with inflammatory bowel disease.

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Patients with inflammatory bowel disease (IBD) are at risk for osteoporosis and fracture.

However, the efficacy of medical treatments for osteoporosis in increasing bone mineral density (BMD) in patients with IBD has not been well characterized.

Drs John Melek and Atsushi Sakuraba from Illinois, USA conducted a meta-analysis and systematic review of controlled trials to evaluate the efficacy and safety of medical therapies used for low BMD in patients with IBD.

The research team searched MEDLINE, EMBASE, Google scholar, the University Hospital Medical Information Network (UMIN) Clinical Trials Registry, and Cochrane Central Register of Controlled Trials for studies that assessed the efficacy of medical treatment for low BMD in patients with IBD.

The team also manually searched abstracts from scientific meetings and bibliographies of identified articles for additional references.

Fluoride increased lumbar spine bone mineral density
Clinical Gastroenterology & Hepatology

The primary outcome assessed was changes in BMD at the lumbar spine.

The researchers also collected data on hip BMD, numbers of new fractures, and adverse effects.

Data were pooled by using random-effects models and by mixed-effects analysis for primary aims, when subgroup analysis by individual drug was possible.

The team analyzed data from 19 randomized controlled studies, of which 2 used calcium and vitamin D as therapies, 13 used bisphosphonates, 4 used fluoride, 1 used calcitonin, and 1 used low-impact exercise.

The researchers found that the pooled effect of bisphosphonates was greater than that of controls in increasing BMD at the lumbar spine and hip with comparable tolerability, and the risk of vertebral fractures was reduced.

The team noted that fluoride increased lumbar spine BMD, but its ability to reduce risk of fracture was unclear.

There was no evidence that the other interventions increased BMD.

Dr Melek and colleague concludes, "On the basis of a meta-analysis, bisphosphonate is effective and well tolerated for the treatment of low BMD in patients with IBD and reduces the risk of vertebral fractures."

"There are insufficient data to support the efficacy of calcium and vitamin D, fluoride, calcitonin, or low-impact exercise."

"However, the small number of randomized controlled trials limited our meta-analysis."

Clin Gastroenterol Hepatol 2014: 12(1): 32-44.e5
08 January 2014

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