P627 Audit of the assessment, prevalence and treatment of osteoporosis in a single-centre cohort of patients with inflammatory bowel disease managed with tumour necrosis factor inhibitor treatment

Abstract

Despite the high prevalence of osteoporosis in patients with inflammatory bowel disease (IBD), the Australian Inflammatory Bowel Disease Audit 2009 found that only 9% of IBD patients who had received over 3 months of steroid treatment had a bone mineral density (BMD) result recorded in the hospital records in the previous 5 years. We postulated that patients receiving tumour necrosis factor inhibitor (TNFi) therapy would be at the highest risk for osteoporosis. The aims of this audit were: (1) record the number of tertiary hospital IBD clinic patients receiving TNFi therapy who had at least one BMD assessment, (2) to record the prevalence of osteoporosis, (3) to record the number who had a change in management as a result of their BMD assessment. This audit was conducted at a single IBD multidisciplinary referral centre. Inclusion criteria: Crohn’s disease or ulcerative colitis, receiving TNFi treatment. Using an IBD database data extracted included: age, gender, body mass index, ever smoked, BMD scan result, fragility fracture, steroid use, disease activity and change in treatment as a result of BMD assessment. Multivariate analysis using logistic regression compared variables. One hundred and ten patients were identified of whom approximately half were female and the majority had never smoked cigarettes (Table 1). Comparison of 110 patients with inflammatory bowel disease treated with a tumour necrosis factor inhibitor (TNFi). Comparison of 110 patients with inflammatory bowel disease treated with a tumour necrosis factor inhibitor (TNFi). The majority of patients (n = 68, 62%) had a DXA scan of whom a minority had osteopenia (n = 26) or osteoporosis (n = 3). Of patients with a DXA scan, 39 (57%) of patients had received at least 1 course of steroids within the 2 years prior to the scan. Four patients had received steroids without a DXA scan. Of patients with osteoporosis, two had been commenced on intravenous anti-resportive therapy (zoledronic acid). Of the 26 patients with osteopenia, 10 (38%) had a change in management. No fragility fractures were identified in any participant. A period ≥2 years between starting TNFi treatment and DXA scan was associated with a reduced BMD (Table 2). Independent predictors of osteoporosis and osteopenia (T score <−1) in 68 patients with inflammatory bowel disease treated with a tumour necrosis factor inhibitor (TNFi). Independent predictors of osteoporosis and osteopenia (T score <−1) in 68 patients with inflammatory bowel disease treated with a tumour necrosis factor inhibitor (TNFi). In this cohort of moderately severe IBD patients managed at a single centre, compliance with DXA scanning was higher than the national average, but rates could be improved further. Osteopenia was common but established osteoporosis relatively uncommon. The outcomes of anti-resorptive therapy in IBD require a larger cohort with long-term follow-up.