Inflammatory Bowel Disease and Risk of Osteoporotic Fractures: A Meta-Analysis

Abstract

Introduction: Inflammatory bowel Disease (IBD), both Ulcerative Colitis (UC) and Crohn's Disease (CD) play an important role as a risk factor for the development of osteoporosis. Literature shows an association between IBD and a decreased bone mineral density in the adult population; however, while most of the studies have reported the association between IBD and osteoporosis, the risk of fractures has not been well reported. The aim of this meta-analysis is to summarize the best evidence that correlates IBD patients and the risk of developing osteoporotic fractures versus control patients without IBS. Methods: A review of the literature using MEDLINE and EMBASE database was performed during November 2017. We included cross sectional and cohort studies that reported relative risks, Odd ratios and Hazard ratios comparing the risk of developing osteoporotic fractures among patient with IBD patients, both Ulcerative Collitis (UC) or Crohn's Disease (CD), versus patients without IBD as controls. Pooled Odd ratio (OR) and 95% confidence interval (CI) were calculated using generic inverse- variance method. Inclusion criteria included: 1) RCT, cohort (either prospective or retrospective), case-control study or cross sectional study published as original study 2) odds ratios (OR), relative risk (RR), hazard ratio (HR 3) subjects without IBD were used as comparators in cohort and cross-sectional study. The Newcastle-Otawa scale was used to determine the quality of the studies. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Results: After the review of the literature, seven studies fulfilled the eligibility criteria established during the analysis. Significant association was found between IBD and osteoporotic fractures with a pooled OR of 1.32 (95% CI, 1.2 - 1.4). Low heterogeneity among the studies was found, I2=42.3. No publication bias was found using Egger regression test p=0.18. Conclusion: We found a significant association between IBD and the risk of developing osteoporotic fractures. The calculated risk was 32% for patients with IBD when compared with normal population. The results showed low heterogeneity and also no publication bias. Among the limitations: all of them were observational studies and the study by Kappelman, included a pediatric population, which at the end did not have a huge influence in the results, but its worth mentioning.637_A Figure 1. Adjusted risk ratio637_B Figure 2. Studies selection criteria