Bone Abstracts

Crohn’s disease often results in abnormalities in bone strength, and ultimately increases the risk of fragility fracture. Up to 55% of patients with Crohn’s disease have bone mineral density in the osteopenia range up to 50% of osteoporosis. Glucocorticoid is frequently used in the treatment of Crohn’s disease and is associated with osteoporosis and increased fracture risk. It has been reported that osteoporotic fractures in patients with Crohn’s disease are 40% more likely than in patients with ulcerative colitis. Malabsorption, vitamin D insufficiency, amenorrhea/hypogonadism, glucocorticoid, and chronic inflammation have all been linked to bone loss in Crohn’s disease. Indicated therapies include bisphosphonates and teriparatide. We report on the novel initial use of teriparatide specifically in two cases of Crohn’s disease. Both reviewed patients had severe osteoporosis with spine fractures. Both experienced remission from Crohn’s disease at the same time as initiating teriparatide therapy and calcium and vitamin D supplementation. Both had the introduction of zoledronic acid intravenous annual infusion antiresorptive therapy subsequent to teriparatide. Increases in spine bone density over the course of this therapy were 48 and 72% in each of our patients, observed over five years and three years, respectively. Similar but lesser magnitude increases in BMD were seen at hip sites over the same timeframe. We attribute these remarkable improvements in bone mineralization to the young age of the patients, the stabilization of their underlying Crohn’s disease, discontinuation of glucocorticoid therapy, improved nutrition, the initial use of bone anabolic therapy followed by antiresorptive therapy, as well as calcium and vitamin D supplementation. A possible role for initial bone anabolic therapy in such patients should be investigated further.