Findings of CT-Derived Bone Strength Assessment in Inflammatory Bowel Disease Patients Undergoing CT Enterography in Clinical Practice

Francisco J. Maldonado, Badr F. Al Bawardy, Avinash K. Nehra, Yong S. Lee, David H Bruining, Mark Charles Adkins, Tony M. Keaveny, Matthew P. Johnson, Jeff L. Fidler, Cynthia H McCollough, Joel Garland Fletcher

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Inflammatory bowel disease (IBD) patients are at risk of developing complications from metabolic bone disease, but the exact prevalence is unknown. We evaluated fracture risk in IBD patients using (1) biomechanical CT analysis (BCT) using bone strength and bone mineral density (BMD), (2) Cornerstone guidelines, and (3) other clinical features predicting fracture risk. METHODS: A retrospective review of consecutive IBD patients who underwent CT enterography (CTE) with BCT from March 2014 to March 2017 was performed. Measured outcomes were overall fracture risk classification (not increased, increased, or high) and femoral neck BMD World Health Organization classification (normal, osteopenia, or osteoporosis). RESULTS: Two hundred fifty-seven patients with IBD underwent CTE and BCT. Fracture risk was classified as not increased in 45.5% (116/255) of patients, increased in 44.7% (114/255), and high in 9.8% (25/255). Femoral neck BMD was classified as normal in 56.8% (142/250), osteopenia in 37.6% (94/250), and osteoporosis in 5.6% (14/250). In multivariate analysis, only increasing age was associated with increased fracture risk (odds ratio, 1.06; 95% confidence interval, 1.04-1.08; P < 0.001). Cornerstone guidelines were met by 35.3% (41/116), 56.1% (64/114), and 76.0% (19/25) of patients in the not increased, increased, and high-risk groups, respectively (P = 0.0001). No Cornerstone criteria were met by 40% (56/139) of patients in the increased and high-risk groups. CONCLUSIONS: Using BCT, increased or high fracture risk was detected in more than half of this cohort, the prevalence being associated with increased age. A significant proportion of patients with increased or high fracture risk did not meet Cornerstone guidelines. Therefore, IBD patients who do not meet Cornerstone guidelines may benefit from BCT screening.

Original languageEnglish (US)
Pages (from-to)1072-1079
Number of pages8
JournalInflammatory bowel diseases
Volume25
Issue number6
DOIs
StatePublished - May 4 2019

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Inflammatory Bowel Diseases
Bone and Bones
Metabolic Bone Diseases
Guidelines
Bone Density
Femur Neck
Osteoporosis
Odds Ratio
Multivariate Analysis
Confidence Intervals

Keywords

  • CT enterography
  • inflammatory bowel disease
  • osteoporosis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Findings of CT-Derived Bone Strength Assessment in Inflammatory Bowel Disease Patients Undergoing CT Enterography in Clinical Practice. / Maldonado, Francisco J.; Al Bawardy, Badr F.; Nehra, Avinash K.; Lee, Yong S.; Bruining, David H; Adkins, Mark Charles; Keaveny, Tony M.; Johnson, Matthew P.; Fidler, Jeff L.; McCollough, Cynthia H; Fletcher, Joel Garland.

In: Inflammatory bowel diseases, Vol. 25, No. 6, 04.05.2019, p. 1072-1079.

Research output: Contribution to journalArticle

Maldonado, Francisco J. ; Al Bawardy, Badr F. ; Nehra, Avinash K. ; Lee, Yong S. ; Bruining, David H ; Adkins, Mark Charles ; Keaveny, Tony M. ; Johnson, Matthew P. ; Fidler, Jeff L. ; McCollough, Cynthia H ; Fletcher, Joel Garland. / Findings of CT-Derived Bone Strength Assessment in Inflammatory Bowel Disease Patients Undergoing CT Enterography in Clinical Practice. In: Inflammatory bowel diseases. 2019 ; Vol. 25, No. 6. pp. 1072-1079.
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abstract = "BACKGROUND: Inflammatory bowel disease (IBD) patients are at risk of developing complications from metabolic bone disease, but the exact prevalence is unknown. We evaluated fracture risk in IBD patients using (1) biomechanical CT analysis (BCT) using bone strength and bone mineral density (BMD), (2) Cornerstone guidelines, and (3) other clinical features predicting fracture risk. METHODS: A retrospective review of consecutive IBD patients who underwent CT enterography (CTE) with BCT from March 2014 to March 2017 was performed. Measured outcomes were overall fracture risk classification (not increased, increased, or high) and femoral neck BMD World Health Organization classification (normal, osteopenia, or osteoporosis). RESULTS: Two hundred fifty-seven patients with IBD underwent CTE and BCT. Fracture risk was classified as not increased in 45.5{\%} (116/255) of patients, increased in 44.7{\%} (114/255), and high in 9.8{\%} (25/255). Femoral neck BMD was classified as normal in 56.8{\%} (142/250), osteopenia in 37.6{\%} (94/250), and osteoporosis in 5.6{\%} (14/250). In multivariate analysis, only increasing age was associated with increased fracture risk (odds ratio, 1.06; 95{\%} confidence interval, 1.04-1.08; P < 0.001). Cornerstone guidelines were met by 35.3{\%} (41/116), 56.1{\%} (64/114), and 76.0{\%} (19/25) of patients in the not increased, increased, and high-risk groups, respectively (P = 0.0001). No Cornerstone criteria were met by 40{\%} (56/139) of patients in the increased and high-risk groups. CONCLUSIONS: Using BCT, increased or high fracture risk was detected in more than half of this cohort, the prevalence being associated with increased age. A significant proportion of patients with increased or high fracture risk did not meet Cornerstone guidelines. Therefore, IBD patients who do not meet Cornerstone guidelines may benefit from BCT screening.",
keywords = "CT enterography, inflammatory bowel disease, osteoporosis",
author = "Maldonado, {Francisco J.} and {Al Bawardy}, {Badr F.} and Nehra, {Avinash K.} and Lee, {Yong S.} and Bruining, {David H} and Adkins, {Mark Charles} and Keaveny, {Tony M.} and Johnson, {Matthew P.} and Fidler, {Jeff L.} and McCollough, {Cynthia H} and Fletcher, {Joel Garland}",
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T1 - Findings of CT-Derived Bone Strength Assessment in Inflammatory Bowel Disease Patients Undergoing CT Enterography in Clinical Practice

AU - Maldonado, Francisco J.

AU - Al Bawardy, Badr F.

AU - Nehra, Avinash K.

AU - Lee, Yong S.

AU - Bruining, David H

AU - Adkins, Mark Charles

AU - Keaveny, Tony M.

AU - Johnson, Matthew P.

AU - Fidler, Jeff L.

AU - McCollough, Cynthia H

AU - Fletcher, Joel Garland

PY - 2019/5/4

Y1 - 2019/5/4

N2 - BACKGROUND: Inflammatory bowel disease (IBD) patients are at risk of developing complications from metabolic bone disease, but the exact prevalence is unknown. We evaluated fracture risk in IBD patients using (1) biomechanical CT analysis (BCT) using bone strength and bone mineral density (BMD), (2) Cornerstone guidelines, and (3) other clinical features predicting fracture risk. METHODS: A retrospective review of consecutive IBD patients who underwent CT enterography (CTE) with BCT from March 2014 to March 2017 was performed. Measured outcomes were overall fracture risk classification (not increased, increased, or high) and femoral neck BMD World Health Organization classification (normal, osteopenia, or osteoporosis). RESULTS: Two hundred fifty-seven patients with IBD underwent CTE and BCT. Fracture risk was classified as not increased in 45.5% (116/255) of patients, increased in 44.7% (114/255), and high in 9.8% (25/255). Femoral neck BMD was classified as normal in 56.8% (142/250), osteopenia in 37.6% (94/250), and osteoporosis in 5.6% (14/250). In multivariate analysis, only increasing age was associated with increased fracture risk (odds ratio, 1.06; 95% confidence interval, 1.04-1.08; P < 0.001). Cornerstone guidelines were met by 35.3% (41/116), 56.1% (64/114), and 76.0% (19/25) of patients in the not increased, increased, and high-risk groups, respectively (P = 0.0001). No Cornerstone criteria were met by 40% (56/139) of patients in the increased and high-risk groups. CONCLUSIONS: Using BCT, increased or high fracture risk was detected in more than half of this cohort, the prevalence being associated with increased age. A significant proportion of patients with increased or high fracture risk did not meet Cornerstone guidelines. Therefore, IBD patients who do not meet Cornerstone guidelines may benefit from BCT screening.

AB - BACKGROUND: Inflammatory bowel disease (IBD) patients are at risk of developing complications from metabolic bone disease, but the exact prevalence is unknown. We evaluated fracture risk in IBD patients using (1) biomechanical CT analysis (BCT) using bone strength and bone mineral density (BMD), (2) Cornerstone guidelines, and (3) other clinical features predicting fracture risk. METHODS: A retrospective review of consecutive IBD patients who underwent CT enterography (CTE) with BCT from March 2014 to March 2017 was performed. Measured outcomes were overall fracture risk classification (not increased, increased, or high) and femoral neck BMD World Health Organization classification (normal, osteopenia, or osteoporosis). RESULTS: Two hundred fifty-seven patients with IBD underwent CTE and BCT. Fracture risk was classified as not increased in 45.5% (116/255) of patients, increased in 44.7% (114/255), and high in 9.8% (25/255). Femoral neck BMD was classified as normal in 56.8% (142/250), osteopenia in 37.6% (94/250), and osteoporosis in 5.6% (14/250). In multivariate analysis, only increasing age was associated with increased fracture risk (odds ratio, 1.06; 95% confidence interval, 1.04-1.08; P < 0.001). Cornerstone guidelines were met by 35.3% (41/116), 56.1% (64/114), and 76.0% (19/25) of patients in the not increased, increased, and high-risk groups, respectively (P = 0.0001). No Cornerstone criteria were met by 40% (56/139) of patients in the increased and high-risk groups. CONCLUSIONS: Using BCT, increased or high fracture risk was detected in more than half of this cohort, the prevalence being associated with increased age. A significant proportion of patients with increased or high fracture risk did not meet Cornerstone guidelines. Therefore, IBD patients who do not meet Cornerstone guidelines may benefit from BCT screening.

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KW - osteoporosis

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