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Screening for low bone mineral density among ulcerative colitis treated with corticosteroids

The latest issue of the American Journal of Gastroenterology evaluates adherence and efficacy of screening for low bone mineral density among ulcerative colitis treated with corticosteroids.

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Ulcerative colitis is associated with an increased risk of metabolic bone disease and fragility fractures.

Dr Nabeel Khan and colleagues from Louisiana, USA assessed the adherence to the guidelines issued by the American Gastroenterology Association (AGA) for the screening for low bone density in ulcerative colitis patients.

The researchers assessed the benefits of dual-energy X-ray absorptiometry (DXA) screening among corticosteroid-treated ulcerative colitis patients.

Nationwide Veterans Affairs system (VA) data were obtained.

Ulcerative colitis patients followed up in the VA between 2001 and 2011 and the occurrence of fragility fractures were identified using International Classification of Diseases, Ninth Revision codes.

The team evaluated exposure to corticosteroid using pharmacy data.

DXA screening was assessed using the VA procedure database.

Overall adherence rate to AGA guidelines was 23%
American Journal of Gastroenterology

Post DXA screening, medication use was also assessed from the pharmacy database.

Cox regression analysis was performed to calculate the hazard ratio (HR) of fragility fractures among those patients who received DXA compared with those who did not.

The researchers included 5,736 patients.

Among them, 1% of patients suffered from fragility fractures during the follow-up period.

Overall adherence rate to AGA guidelines was 23%.

The research team found that the adherence rate was highest among postmenopausal women, and lowest among men above 50 years of age.

The team noted that ulcerative colitis patients who received DXA screening were more likely to be started on bisfosfonates, calcitonin, vitamin D, and calcium compared with those who did not receive screening.

Those who received DXA screening were half as likely to develop fragility fractures as compared with those who did not receive screening.

The team observed that benefits were more prominent among those with higher corticosteroid exposure.

Dr Khan's team concludes, "Rates of DXA screening were low among corticosteroid-treated ulcerative colitis patients."

"Those who received DXA screening were more likely to be started on antiresorptive therapy and supplemental medications, and had a 50% reduction in the risk of fragility fractures."

"More efforts should be directed toward raising the adherence to AGA guidelines and the awareness of DXA benefits."

Am J Gastroenterol 2014; 109:572–578
17 April 2014

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