JCEM：溃疡性结肠炎患者有更高的低骨矿密度患病率

炎症性肠病的患者常常伴有低骨矿密度（BMD）。为了在溃疡性结肠炎（UC）的男性患者中间，评估低BMD（骨质疏松或低骨量）和脆性骨折的患病率和预测因子，来自美国新奥尔良市杜兰大学医学院的Nabeel Khan博士及其团队进行了一项研究，该研究发现男性UC患者低BMD患病率高于普通人群。该研究结果在线发表在2013年4月17日的美国《临床内分泌代谢杂志》（The journal of clinical endocrinology & metabolism）上。

该研究是一项回顾性的数据分析，在全国退伍军人（VA）医疗保健系统中进行。入选2001至2011年期间在VA系统随访的、使用ICD–9编码确认的男性UC患者。使用ICD–9编码确认患者伴有低BMD和脆性骨折。利用药物数据评估患者类固醇暴露情况。使用多元分析确定全身性类固醇对低BMD和脆性骨折风险的独立影响。

该研究结果表明，确认了34665例患者，在他们中间，31%使用类固醇。那些使用类固醇和没有使用类固醇患者中间低BMD患病率分别为15.8%和7.1%，P＜0.001。那些伴有骨质疏松、低骨量和那些不伴有低BMD患者的脆性骨折患病率分别为7.9%、4.4%和1.1%，P＜0.001。类固醇暴露显示剂量反应模型，在控制其他可能的预测因子后，与非类固醇使用者相比，强的松暴露累积大于11136mg（十等分）的患者更有可能发生低BMD（OR=8.9，P＜0.001）和脆性骨折（OR=1.8，P＜0.001）。

该研究发现，在这个全国性的队列中，低BMD的患病率高于普通男性人群报道的数据。类固醇使用的累积与低BMD风险之间密切相关。类固醇和低BMD是脆性骨折的独立危险因素。

与结肠炎相关的拓展阅读：

• Microbiome：新型标志物或可识别婴儿坏死性小肠结肠炎风险
• JPGN：粪便移植或可治疗溃疡性结肠炎
• APT：周末手术治疗溃疡性结肠炎增加并发症风险
• ALIMENT PHARM THERAP：他克莫司显示对难治性溃疡性结肠炎有短期疗效
• FDA批准Humira用于治疗某些溃疡性结肠炎患者 更多信息请点击：有关结肠炎更多威廉亚洲官网

Prevalence and Predictors of Low Bone Mineral Density in Males with Ulcerative Colitis.
Abstract
Context:Low bone mineral density (BMD) is common in patients with inflammatory bowel diseasesObjective:To assess the prevalence and the predictors of low BMD (osteoporosis or osteopenia) and fragility fractures among men with Ulcerative Colitis (UC).Design:Retrospective database analysis.Setting:Nationwide Veterans Affairs (VA) healthcare system.Patients:Male UC patients who were followed in the VA system between 2001 and 2011 were identified using ICD-9 codes.Main Outcome Measures:We identified patients with low BMD and fragility fractures using ICD-9 codes. Steroids exposure was assessed using pharmacy data. Multivariate analysis was used to identify the independent effect of systemic steroids on the risk of low BMD and fragility fractures.Results:We identified 34,665 patients. Among them, 31% used steroids. Prevalence of low BMD was 15.8% and 7.1% among those who used and did not use steroids respectively, p<0.001. Prevalence of fragility fractures was 7.9%, 4.4% and 1.1% for those with osteoporosis, osteopenia and those without low BMD respectively, p<0.001. Steroids exposure showed dose-response pattern, patients who had accumulative prednisone exposure of >11,136 mg (tenth decile) were more likely to develop low BMD (OR=8.9, p<0.001) and fragility fractures (OR=1.8, p<0.001) as compared to non-steroids users after controlling for other possible predictors.Conclusion:In this nationwide cohort, prevalence of low BMD was higher than what was reported for the general male population. There was a strong correlation between the cumulative steroid utilization and the risk of low BMD. Both Steroids and low BMD were independent risk factors for fragility fractures.