Osteoporosis is common in patients with IBD [15, 16], which is confirmed using dual-energy X-ray absorptiometry that measures bone mineral density (BMD). Further studies and debates need to be undertaken to determine the absolute fracture risk, the contribution of steroids and the role of prophylaxis in treating osteoporosis. Population-based data on fracture incidence suggest only a small increased risk of fracture amongst patients with IBD compared with the general population [16]. A comparative study has evaluated, through the use of bone biopsy, microarchitecture and bone reshaping both in menopause patients and subjects being treated with corticosteroids (7.5 mg per day of prednisone for at least 6 months). This study revealed that patients treated with corticosteroids presented bones with smaller volume (bone volume/tissue volume) and reduced thickness of both trabecular and cortical bone as well as a smaller number of osteoids [17].

If therapy using corticosteroids is undertaken, it is recommended that the minimum effective dose be taken and that therapy be periodically interrupted. Use of calcium and vitamin D may be helpful to contrast the effects of corticosteroids, which can cause secondary hyperparathyroidism, a reduction in osteoblastic activity and have a negative effect on kidney and bowel calcium transport [18].

"For patients with IBD and low BMD, it is possible that calcium and Vitamin D supplementation alone may be sufficient unless the patient is also receiving corticosteroids or has a history of fragility fractures. . . . Combination antiresorptive therapy (typically a bisphosphonate combined with oestrogen or ralox-ifene) may produce greater gains in bone mass than either agent alone, but the use of two antiresorptive agents is not recommended because the benefit on fracture risk has not been demonstrated and there is increased cost and side effects" [16]. Bernstein and Leslie suggested that "to date, there remains no therapy proven to be efficacious in inflammatory bowel disease-related osteoporosis: however, calcium and vitamin D supplementation and bisphosphonates have their roles" [16].

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