Factors Determining Screening for Osteoporosis in Inflammatory Bowel Disease - Are We Following Guidelines?

Abstract

Purpose: Osteoporosis is a well recognized morbidity associated with Inflammatory Bowel Disease (IBD) with a significant impact on patient's health. The aim of this study is to evaluate the practice of management of osteoporosis in a tertiary care center's out patient IBD clinic and its variance from the proposed guidelines. Methods: A retrospective chart review of 204 IBD patients was conducted and the following data was recorded: age, gender, race, disease duration, body weight, diagnosis of Ulcerative colitis (UC) or Crohn's disease (CD), location of disease, surgeries in past, use of steroids, anti-TNF agents, calcium and vitamin D supplements, bisphosphonate use, dual energy X-ray absorptiometry (DEXA) scans and their results, any osteoporosis related complications as documented in the chart. Data was then compared to American Gastroenterology Association guidelines for management of osteoporosis published in 2003. Risk Factors assessed were history of low trauma fracture, smoking, advanced age>60 years, post menopausal state, steroid use >3months or current use and low body weight. Results: Out of 204 charts reviewed- 70 patients (mean age-41.8 years, 57% males, 42.8% females) were referred for a DEXA scan and 134 patients (mean age-40.4 years, 46% males, 53% females) were not referred for a DEXA scan. Both groups were predominantly Caucasian. There was no significant difference in disease type-UC versus CD. One hundered and fifty three patients had any of the above mentioned risk factors for osteoporosis. Only 34.6 % of these patients were referred for a DEXA scan. Out of which 15% had osteoporosis and 41.5 % had osteopenia. No risk factors were found in 51 patients, 31% of who were referred for a DEXA scan- 6 % had osteoporosis and 31 % had osteopenia. Table 1 compares the risk factors and significant demographics of patients referred for a DEXA scan and those who were not. Patients with longer duration of follow up(p=0.0138) and steroid use irrespective of duration of use(p=0.017) were found to be significant factors influencing referral for a DEXA scan.Table 1: Comparison of risk factors and demographics between patients referred for DEXA scan and those who were notConclusion: Guidelines for osteoporosis screening were followed approximately for one-third of the population that met criteria and the rate of osteoporosis (15%) detected was concordant with rates reported in previously done studies. Incidence of osteoporosis was much lower in patients with no risk factors. Decision to refer a patient for DEXA scan was influenced by factors other than those recommended by AGA guidelines.