Exposure to sunshine, as any medication, should be in appropriate doses
and in safe periods of the day: sun should be avoided between 11 am.
and 2 pm. in the spring and autumn, and between 10 am. and 3 pm. in the
summer (or maybe in even broader range depending on individual tolerance).
BONE DISEASE IN VITAMIN D-DEFICIENT PATIENTS WITH CROHN’S DISEASE.
Vogelsang H; Ferenci P; Woloszczuk W; Resch H; Herold C; Frotz S; Gangl
A, 1st Department of Gastroenterology and Hepatology, Allgemeines Krankenhaus;
Vienna, Austria. Dig Dis Sci, 1989 Jul, 34:7, 1094-9
Vitamin D deficiency is frequently observed in patients with Crohn’s
disease and may be associated with an increased risk of development of
metabolic bone disease. To estimate the incidence of metabolic bone disease
by noninvasive methods, 31 patients (17-75 years old) with Crohn’s disease
and low 25 hydroxyvitamin D (25-OHD) levels in winter were investigated
in the following summer by measuring the bone mineral content (BMC)
of the distal radius by single photon absorptiometry and the cortical
area ratio (CAR) calculated from radiographs of the right hand and by x-ray
of the lumbar spine. Forty-five percent of the patients showed signs
of metabolic bone disease. BMC and CAR correlated with 25-OHD serum
levels (P less than 0.05), especially in men. Furthermore, the amount
of sun exposure has an influence not only on 25-OHD serum levels both in
summer and in winter (P = 0.0006), but also on the BMC (P =
0.07). Consequently, vitamin D deficiency is of major importance for
the development of metabolic bone disease in patients with Crohn’s disease.
Vitamin D deficiency can be prevented by increasing sun exposure and long-term
vitamin D supplementation.
OSTEOPOROSIS IN INFLAMMATORY BOWEL DISEASE
*M. Szathmári, Zs. Tulassay, L. Prónai L, T. Zágoni,
A. Németh (2nd Dept. Medicine, *1st Dept. of Medicine, Semmelweis
Medical Univ., Clinical Gastroenterology Research Unit, Hungary, Budapest).
Fifth International Semmelweis Symposium, 1996
Purpose: The aim of our study was to evaluate bone metabolism in colitis
ulcerosa and Crohn's disease and assess whether ostopenia represents rather
a symptom of the disease then a consequence of the corticosteroid therapy.
Methods: Twenty-two patients with ulcerative colitis (9 male, 13 female,
mean age 26 y.o., range 22-71) and 23 with Crohn's disease (13 male, 10
female, mean age 42 y.o., range 19-54) were involved in the study. Mean
duration of ulcerative colitis was 8.2 years (range 1-20) and that for
Crohn's disease was 5.3 years (range 1-20). The bone mineral content and
density of the bone turnover were measured by dual X-ray absorptiometry
at the lumbar spine and femoral neck, and by single photon absorptiometry
at the non-dominant radius midshaft. Other biochemical parameters of bone
mineral turnover were also evaluated. Results: A mild osteopenia was detected
in approximately one-third of patients with inflammatory bowel disease
(Z-score < -1.0). The mean lumbar spine Z-score was significantly
lower in Crohn's patients without corticosteroid therapy (Z-score=
-0.65, p<0.0.5) than that of the normal population (0). On
the other hand, Z-score values were not lower in Crohn's patients treated
with corticosteroid when compared to that in patients without this therapy.
Z-score of colitis ulcerosa patients without corticosteroid therapy did
not show a significant deviation from the normal population. On the other
hand, colitis ulcerosa patients with corticosteroid treatment had a significantly
lower Z-score (-0.67, p<0.05) compared to healthy controls. All biochemical
parameters of bone resorption and formation were within the normal range.
Conclusion: Crohn's disease but not colitis ulcerosa seems to be an
independent risk factor to induce osteopenia. Steroid use is associated
with a decrease of bone mineral density only in colitis ulcerosa.
PREVENTION OF BONE MINERAL LOSS IN PATIENTS WITH CROHN'S DISEASE BY
LONG-TERM ORAL VITAMIN D SUPPLEMENTATION
Vogelsang H; Ferenci P; Resch H; Kiss A; Gangl A. Eur J Gastroenterol
Hepatol: 7:7:609-14 (1995)
OBJECTIVE: To determine whether long-term dietary supplementation with
low doses of vitamin D
helps to prevent bone loss and the development of osteoporosis or osteomalacia
in out-patients
with Crohn's disease. DESIGN: A randomized controlled study. SETTING:
The out-patient clinic of a tertiary centre (university hospital). PATIENTS:
Seventy-five out-patients (31 men and 44 women, aged 16-77 years) with
Crohn's disease. INTERVENTIONS: All patients were randomly assigned to
receive either an oral supplement of 1000 IU/day vitamin D for 1 year or
no supplement. Bone
mineral density, assessed in the distal part of the nondominant forearm
using single photon
absorptiometry, and serum levels of 25-hydroxyvitamin D, assessed using
a competitive protein
binding assay, were measured before and after the period of dietary
supplementation. MAIN
OUTCOME MEASURE: Relative change of bone mineral density. RESULTS:
Serum levels of
25-hydroxyvitamin D increased in 57% of patients who received a supplement
(compared with 37% of control patients). Bone mineral density decreased
significantly in control patients median -7%,
interquartile range -12.6-(+0.4%) but not in patients who received
a supplement median -0.2%,
interquartile range -3.8-(+14%); P < 0.005. Increases in bone mineral
density were especially
prevalent among patients who received the supplement and had normal
serum levels of
25-hydroxyvitamin D (68%), whereas increases occurred in only 18% of
patients with low serum
levels of 25-hydroxyvitamin D (P = 0.008). Patients without an intestinal
resection and receiving the
vitamin D supplement had a marginally greater increase in bone mineral
content than patients who
had undergone a resection (P = 0.05). CONCLUSION: Long-term oral
vitamin D supplementation seems to be an efficient means of preventing
bone loss in patients with Crohn's disease and could be recommended, especially
for patients at high risk of osteoporosis.