Mini Review
Volume 8 Issue 3 - 2021
Review: Epidemiology and Pathophysiology of Osteoporosis in Inflammatory Bowel Disease
Kakkar Apeksha*
M.B.B.S, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, India
*Corresponding Author: Kakkar Apeksha, M.B.B.S, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, India.
Received: January 28, 2021; Published: February 12, 2021


Osteoporosis is a common clinical pathology encountered in everyday medicine and while the foremost population that comes to mind is elderly postmenopausal women, it may affect varied age-groups and indeed, has several causative factors. One such interesting association is between gastrointestinal illnesses like IBD and osteoporosis. Osteoporosis is important to diagnose because it increases the likelihood of fractures and in IBD patients, this should be especially noted because they are often on glucocorticoid therapy, which on its own is responsible for an increase in fragility fractures. With age and decrease in estrogen, the loss of bone mineral density increases. As a result, patients are at an increased risk of developing osteoporosis and subsequent fractures. In IBD subjects, paramount aspect is the early onset of osteopenia and osteoporosis. Hence, guiding us towards the understanding that in addition to age, genetics, and lifestyle, there are a number of factors operating at a molecular and nutritional status level that lead to osteoporosis. This review article discusses the epidemiology and pathophysiology of osteoporosis in IBD patients to help garner an in-depth view of the imbalance in the several factors that play a role in the pathogenesis and provide a composite view of this common association.

Keywords: Inflammatory Bowel Disease (IBD); Crohn’s Disease (CD); Ulcerative Colitis (UC); Osteoporosis


  1. Sairenji T., et al. “An Update on Inflammatory Bowel Disease”. Primary Care: Clinics in Office Practice - Journal 4 (2017): 673-692.
  2. Krela-Kaźmierczak I., et al. “Osteoporosis in gastrointestinal diseases”. Advances in Clinical and Experimental Medicine 1 (2016): 185-190.
  3. Jeon YK., et al. “The diagnosis of osteoporosis”. Journal of the Korean Medical Association 11 (2016): 842-846.
  4. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group”. Geneva, World Health Organization, 1994 (WHO Technical Report Series 843 (1994).
  5. Pollak RD., et al. “Femoral neck osteopenia in patients with inflammatory bowel disease”. The American Journal of Gastroenterology 9 (1998): 1483-1490.
  6. Targownik LE., et al. “Inflammatory bowel disease and the risk of osteoporosis and fracture”. Maturitas 4 (2013): 315-319.
  7. Smith CB and Smith DA. “Mechanical Properties of Human Femoral Compacta”. Changes (1976): 496-502.
  8. Bernstein CN and Leslie WD. “The pathophysiology of bone disease in gastrointestinal disease”. European Journal of Gastroenterology and Hepatology 8 (2003): 857-864.
  9. Rodríguez-Bores L., et al. “Basic and clinical aspects of osteoporosis in inflammatory bowel disease”. World Journal of Gastroenterology 46 (2007): 6156-6165.
  10. Katz S and Weinerman S. “Osteoporosis and gastrointestinal disease”. Journal of Gastroenterology and Hepatology 8 (2010): 506-517.
  11. Soriano R., et al. “Current and future treatments of secondary osteoporosis”. Best Practice and Research Clinical Endocrinology and Metabolism 6 (2014): 885-894.
  12. Schoon EJ. “Bone mineral density in patients with recently diagnosed inflammatory bowel disease”. Gastroenterology5 (2000): 1203-1208.
  13. Compston JE. “Osteoporosis, Corticosteroids and Inflammatory Bowel Disease”. Alimentary Pharmacology and Therapeutics 3 (1995): 237-250.
  14. Silvennoinen JA., et al. “A controlled study of bone mineral density in patients with inflammatory bowel disease”. Gut 1 (1995): 71-76.
  15. Bernstein CN and Blanchard JF. “The Incidence of Fracture among Patients with Inflammatory Bowel Disease”. Saudi Medical Journal 12 (2019): 1290-1293.
  16. Bucay N., et al. “Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification”. Genes and Development 9 (1998): 1260-1268.
  17. Takeuchi T., et al. “Effects of the anti-RANKL antibody denosumab on joint structural damage in patients with rheumatoid arthritis treated with conventional synthetic disease-modifying antirheumatic drugs (DESIRABLE study): A randomised, double-blind, placebo-controlled phase”. Annals of the Rheumatic Diseases 7 (2019): 899-907.
  18. Mochizuki T., et al. “Effects of denosumab treatment on bone mineral density and joint destruction in patients with rheumatoid arthritis”. The Journal of Bone and Mineral Metabolism 4 (2018): 431-438.
  19. Tanaka S. “Emerging anti-osteoclast therapy for rheumatoid arthritis”. The Journal of Orthopaedic Science 5 (2018): 717-721.
  20. Kong YY., et al. “Osteoprotegerin ligand: A common link between osteoclastogenesis, lymph node formation and lymphocyte development”. Immunology and Cell Biology 2 (1999): 188-193.
  21. Lo Iacono N., et al. “Osteopetrosis rescue upon RANKL administration to Rankl-/- mice: A new therapy for human RANKL-dependent ARO”. Journal of Bone and Mineral Research 12 (2012): 2501-2510.
  22. Kung YY., et al. “Activated T cells regulate bone loss and joint destruction in adjuvant arthritis through osteoprotegerin ligand”. Nature6759 (1999): 304-309.
  23. Fragoulis GE., et al. “JAK-inhibitors. New players in the field of immune-mediated diseases, beyond rheumatoid arthritis”. Rheumatology 58 (2019): i43-54.
  24. Seshasayee D., et al. “A novel in vivo role for osteoprotegerin ligand in activation of monocyte effector function and inflammatory response”. Journal of Biological Chemistry 29 (2004): 30202-30309.
  25. Anderson DM., et al. “A homologue of the TNF receptor and its ligand enhance T-cell growth and dendritic-cell function”. Nature 6656 (1997): 175-179.
  26. Weitzmann MN., et al. “Interleukin-7 stimulates osteoclast formation by up-regulating the T-cell production of soluble osteoclastogenic cytokines”. Blood5 (2000): 1873-1878.
  27. Bertolini DR., et al. “Stimulation of bone resorption and inhibition of bone formation in vitro by human tumour necrosis factors”. Nature 6053 (1986): 516-518.
  28. Lee SK., et al. “RANKL-stimulated osteoclast-like cell formation in vitro is partially dependent on endogenous interleukin-1 production”. Bone 5 (2006): 678-685.
  29. Ishimi Y., et al. “IL-6 is produced by osteoblasts and induces bone resorption”. Journal of Immunology 10 (1990): 3297-3303.
  30. Ferrari-Lacraz S and Ferrari S. “Do RANKL inhibitors (denosumab) affect inflammation and immunity?” Osteoporosis International 2 (2011): 435-446.
  31. Javorsky BR., et al. “Vitamin D Deficiency in Gastrointestinal Disease” 3.1 (2006).
  32. Jahnsen J., et al. “Vitamin D status, parathyroid hormone and bone mineral density in patients with inflammatory bowel disease”. Scandinavian Journal of Gastroenterology 2 (2002): 192-199.
  33. Mizuno A., et al. “Severe osteoporosis in mice lacking osteoclastogenesis inhibitory factor/osteoprotegerin”. Biochemical and Biophysical Research Communications 3 (1998): 610-615.
  34. Bellido T., et al. “Regulation of interleukin-6, osteoclastogenesis, and bone mass by androgens. The role of the androgen receptor”. Journal of Clinical Investigation 6 (1995): 2886-2895.
  35. Raftery T., et al. “New Roles and Therapeutic Potential in Inflammatory Bowel Disease”. Current Drug Metabolism 9 (2012): 1294-1302.
  36. Nic Suibhne T., et al. “Vitamin D deficiency in Crohn’s disease: Prevalence, risk factors and supplement use in an outpatient setting”. Journal of Crohn's and Colitis 2 (2012): 182-188.
  37. Bernstein CN. “Inflammatory bowel diseases as secondary causes of osteoporosis”. Current Osteoporosis Reports 3 (2006): 116-123.
  38. Loftus EV. “Management of extraintestinal manifestations and other complications of inflammatory bowel disease”. Current Gastroenterology Reports 6 (2004): 506-513.
Citation: Kakkar Apeksha. “Review: Epidemiology and Pathophysiology of Osteoporosis in Inflammatory Bowel Disease”. EC Gastroenterology and Digestive System 8.3 (2021): 110-115.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

May Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the May issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before May 28, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to