| Influence of ileal pouch anal anastomosis on bone loss in ulcerative colitis patients. | |
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MedLine Citation:
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PMID: 21939915 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND AND AIM: Patients with ulcerative colitis (UC) are at an increased risk for low bone mineral density (BMD). It is unclear whether proctocolectomy with ileal pouch-anal anastomosis (IPAA) for UC alters the risk of bone loss. The aim of this study was to compare BMD in UC patients with and without IPAA. METHODS: A total of 267 patients with UC and IPAA (study group) were compared to 119 UC patients without IPAA (control group) in this cross-sectional study. The demographic and clinical variables including dual-energy X-ray absorptiometry scan results were compared. Patients were classified as having normal or low BMD, based on the criteria by the International Society for Clinical Densitometry. Univariate and multivariate analyses were performed to assess risk factors associated with low BMD. Age, gender, race, smoking status, steroid use, alcohol use, body mass index, years of absent estrogen protection, use of calcium, vitamin D supplements and disease duration were selected as covariates. RESULTS: 83 (31.1%) had low BMD in the study group vs. 18 (15.1%) in the control group (p=0.001). 2/13 (15.4%) had low BMD before surgery. The mean age of patients in the study and control groups were 44.7±14.1 vs. 52.4±17.7years, respectively (p<0.001). The hip BMD was lower in the study group (0.93±0.17g/cm2) than that in the control group (0.98±0.17g/cm2) (p=0.038). Fragility fracture was documented in 23 (8.6%) patients in the study group vs. 3 (2.5%) in the control group (p=0.038) Sixty-four (24.0%) of the study group patients were using corticosteroids after surgery in contrast to 93 (78.2%) in the control group (p<0.001). On multivariable analyses, covariate adjusted factors associated with a low BMD in UC patients were advanced age [odds ratio (OR) 1.51 per 5years; 95% confidence interval [CI], 1.34-1.71], low body mass index (OR=2.37 per 5kg/m(2) decrease; 95% CI, 1.68-3.36), and the presence of IPAA (OR=6.02; 95% CI, 2.46-14.70). For the 13 IPAA patients who had information available, BMD before IPAA was low. After a median of 46 (Range 7-84) months after IPAA, BMD improved in 7/13 patients (53.8%), while it continued to be low in 6/13 (46.2%) patients. CONCLUSIONS: Low BMD is common in patients with UC. The risk appears to persist even after colectomy and IPAA surgery suggesting that these patients need to be monitored for bone loss. |
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Authors:
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Udayakumar Navaneethan; Ling Shen; Preethi G K Venkatesh; Jeffrey Hammel; Viral Patel; Feza H Remzi; Ravi P Kiran |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-5-10 |
Journal Detail:
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Title: Journal of Crohn's & colitis Volume: 5 ISSN: 1876-4479 ISO Abbreviation: - Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-9-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101318676 Medline TA: J Crohns Colitis Country: - |
Other Details:
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Languages: ENG Pagination: 415-422 Citation Subset: - |
Copyright Information:
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Copyright © 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved. |
Affiliation:
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Department of Gastroenterology, Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, OH 44195, United States. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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