Abstract Background/Aims Low bone mineral density (BMD) in patients with inflammatory bowel disease (IBD) is driven by systemic inflammation, nutritional deficiencies and exposure to glucocorticoids. We evaluated the management of low BMD in IBD patients in the osteoporosis service at our centre against NICE NG226, NOGG 2021 and British Society of Gastroenterology guidelines, and explored ideas for improving clinical practice. Methods This retrospective study reviewed patients with IBD and DEXA-confirmed low BMD between 2007-2025 within the osteoporosis service at Basildon University Hospital, UK. Data were collected from electronic patient records and analysed using appropriate statistical methods. Results Our IBD cohort of 52 patients had a mean age of 41.6 years (range 8-80 years) at IBD diagnosis and 54.1 years (range 17-80 years) at low BMD diagnosis. Eighty per cent (n = 42) were women, with two-thirds postmenopausal. Crohn’s disease (CD) accounted for 58% (n = 30), and ulcerative colitis (UC) for 42% (n = 22) of patients. Steroid exposure occurred in 40%, bowel resection in 35%, and vitamin-D deficiency in 33% (all treated). Baseline DEXA was performed in all patients; median interval for repeat DEXA was 8.6 years, exceeding the recommended 3-5 years. Pharmacological treatment was prescribed in 94%, with oral bisphosphonates (67%), denosumab (39%), zoledronate (22%), teriparatide (6%), and calcium/vitamin D (18%). Fragility fractures occurred in 33% pre-diagnosis and 10% during treatment. Lumbar spine BMD improved significantly across IBD groups, representing the most responsive site to treatment (Table 1). UC patients showed stronger treatment response, with improvement in BMD across skeletal sites, whereas CD patients had gains largely confined to the lumbar spine (Tables 2-3). This suggests a site-specific improvement in CD subgroup, predominantly in trabecular bone density. At baseline, postmenopausal women exhibited the lowest mean BMD in the lumbar spine, whereas men showed the lowest BMD at the hip (Table 4). Conclusion Inflammatory burden and more extensive small bowel disease in CD may contribute to more persistent vitamin D deficits and less skeletal recovery compared to UC. This cohort of patients may benefit from more targeted bone health interventions and surveillance. Incorporating routine vitamin D testing and timely DEXA every 3-5 years as part of integrated care pathways will better align clinical practice with NICE, NOGG, and BSG guidelines. Disclosure K.K. Garg: None. J. Tseng: None. A. Nandagudi: None.
Garg et al. (Wed,) studied this question.