©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Updated bone mineral density status in Saudi patients with inflammatory bowel disease
Mohammed Ewid, Internal Medicine Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
Mohammed Ewid, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Nawaf Al Mutiri, Khalid Al Omar, Amal N Shamsan, Awais A Rathore, Gastroenterology Department, King Fahad Specialist Hospital, Buraidah 52366, Al-Qassim, Saudi Arabia
Nazmus Saquib, Epidemiology Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
Anas Salaas, Omar Al Sarraj, Yaman Nasri, Ahmed Attal, Abdulrahman Tawfiq, Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
Hossam Sherif, Critical Care Medicine Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
Hossam Sherif, Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Author contributions: Ewid M, Al Mutiri N, Saquib N, and Sherif H conceived of the idea, developed the theory; Ewid M was the principle investigator; all author contributed towards methodology and towards the writing of the paper, and have read and approved the final manuscript.
Supported by Sulaiman Al Rajhi University, Saudi Arabia, from the Annual Budget of their Research Unit.
Institutional review board statement: The study received ethical approval from the Regional Research Ethics Committee-Qassim province, Ministry of Health, Saudi Arabia (approval number 20180102).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mohammed Ewid, MD, Assistant Professor, Internal Medicine Department, College of Medicine, Sulaiman Al Rajhi University, PO Box 777, Bukairyah 51941, Al-Qassim, Saudi Arabia. firstname.lastname@example.org
Received: May 8, 2020
Peer-review started: May 8, 2020
First decision: June 8, 2020
Revised: June 15, 2020
Accepted: August 22, 2020
Article in press: August 22, 2020
Published online: September 21, 2020
Inflammatory bowel disease (IBD) is showing an increasing trend in newly industrialized countries worldwide, including Saudi Arabia. Reduced bone mineral density (BMD) is a major documented extraintestinal complication in patients with IBD. As with other IBD patients, Saudi patients with IBD will have increased fracture risk and lower quality of life if not properly screened for reduced BMD.
Little is known about how much reduced BMD occurs among Saudi patients with IBD or about the predisposing factors in that population. Our study gives an update about reduced BMD among adult Saudi patients with IBD. We hope it will help health care providers curb the anticipated complications through proper preventive and screening measures.
We aimed to assess the current burden of reduced BMD and its possible risk factors among adult Saudi patients with IBD. Moreover, we investigated any possible variations between Crohn’s disease (CD) and ulcerative colitis (UC) patients, either in the disease burden or its related risk factors.
Ninety adult patients with IBD - 62 CD and 28 UC - were recruited from King Fahad Specialist Hospital gastroenterology clinics in the city of Buraidah, Saudi Arabia. Demographics, clinical workups and dual x-ray energy absorptiometry (DXA) scan data were obtained. Patients were divided into two groups (CD and UC) to explore their clinical characteristics and possible risk factors for reduced BMD. Appropriate statistical tests were used according to the variables. A P < 0.05 was considered significant.
Patients with CD were at higher risk for reduced BMD than those with UC; 19% of CD patients had osteopenia, and 37% had osteoporosis, while among the UC patients, 7% had osteopenia, and 25% had osteoporosis (P value < 0.05). In the CD group, the lowest t-score showed a statistically significant correlation with body mass index (BMI) (r = 0.45, P < 0.001), best cut-off value at ≤ 23.43 (m/kg2); area under the curve was 0.73 (95%CI: 0.59–0.84). In the UC group, the lowest t-score showed only statistically significant correlation with the lumbar z-score (r = 0.82, P < 0.05) and femur z-score (r = 0.80, P < 0.05).
There is still an increased risk of reduced BMD for Saudi patients with IBD, more so in CD patients. Low BMI is a significant risk factor for reduced BMD in CD patients.
We recommend further prospective multicenter studies among adult Saudi patients with IBD for a better assessment of reduced BMD risk factors and to investigate the current DXA screening practices among those patients.