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Journal of Digestive Diseases 2014; 15; 116–123
doi: 10.1111/1751-2980.12118
Original article
Vitamin D levels and bone metabolism in Chinese adult patients with inflammatory bowel disease Bei TAN,* Pan LI,*1 Hong LV,* Yue LI,* Ou WANG,† Xiao Ping XING† & Jia Ming QIAN* Departments of *Gastroenterology and †Endocrinology, Key Laboratory of Chinese Health Ministry, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
OBJECTIVE: We aimed to investigate the serum 25-hydroxyvitamin D3 (25[OH]D3) levels and bone metabolism in adult Chinese patients with inflammatory bowel disease (IBD) and to evaluate the correlation between vitamin D levels and the disease activity as well as the potential risk factors. METHODS: Age- and gender-matched cohort of IBD patients (124 with ulcerative colitis [UC] and 107 with Crohn’s disease [CD]) and 122 healthy controls were enrolled in this study. Serum levels of 25(OH)D3 and bone mineral density (BMD) were measured, and the correlation between the two parameters and the severity of the disease as well as the clinical risk factors were analyzed. RESULTS: Serum 25(OH)D3 levels were lower in UC (10.32 ± 4.46 ng/mL, P < 0.001) and CD patients (11.57 ± 5.02 ng/mL, P = 0.029) than that in
healthy controls (12.87 ± 4.40 ng/mL). 25(OH)D3 levels were negatively correlated with the disease severity of both UC (r = −0.371, P < 0.001) and CD (r = −0.285, P = 0.030). The incidences of osteopenia and osteoporosis were high in the IBD patients (37.9% and 3.2% in UC and 30.8% and 4.7% in CD, respectively). Cumulative quantity of glucocorticoids use was significantly associated with osteopenia and osteoporosis in both UC (odds ratio [OR] 1.219, 95% confidence interval [CI] 1.054−1.410, P = 0.008) and CD patients (OR 1.288, 95% CI 1.033−1.606, P = 0.025).
CONCLUSIONS: Vitamin D deficiency is likely to occur in Chinese patients with IBD and is closely associated with the severity of the disease. Glucocorticoids accumulation is a risk factor for osteopenia and osteoporosis.
KEY WORDS: bone mineral density, Crohn’s disease, inflammatory bowel disease, ulcerative colitis, vitamin D.
Correspondence to: Jia Ming QIAN, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. Email: [email protected] 1
Present address: Department of Gastroenterology, First Affiliated Hospital of Chongqing Medical University. Conflict of interest: None. © 2013 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd
116
INTRODUCTION Inflammatory bowel disease (IBD) is a group of diseases characterized by recurrent episodes of intestinal inflammation, including ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis. The etiology of IBD is complex, which includes genetic susceptibility of the hosts, environmental factors and abnormal mucosal immune responses to antigenic materials such as symbiotic bacteria in the gut. Vitamin D has been shown to have anti-inflammatory,
Journal of Digestive Diseases 2014; 15; 116–123 anti-cancer and immune regulatory effects, in addition to its traditional role of regulating calcium and phosphorus metabolism.1–5 Recently, the role of vitamin D in IBD is of increasing interest worldwide. Several retrospective studies, consisting of both referred and population-based cohorts from the Western hemisphere, reported that vitamin D deficiency was commonly observed in IBD patients and was independently related with the disease activity.6,7 Although seldom reported, the relationship among vitamin D levels, bone loss and IBD has been prospectively evaluated in a small sample of Chinese population.8 In this study, we aimed to investigate the serum vitamin D levels and bone metabolism in adult Chinese patients with IBD to determine the incidence of vitamin D deficiency, osteopenia and osteoporosis, and to evaluate the correlation between serum vitamin D levels and the severity of the disease as well as the potential risk factors. PATIENTS AND METHODS
Vitamin D and BMD in Chinese IBD patients
117
Demographic and clinical characteristics of the participants We collected the data on the participants’ age, gender, menstruation status in women and body mass index (BMI) as well as the following clinical characteristics: duration and clinical phenotype of the disease, location of the lesion, extent of UC, the Mayo index,9 the simplified CD activity index (CDAI) score,9 erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (hsCRP), bone metabolic markers (alkaline phosphatase [ALP], calcium and phosphorus), concurrent medications for IBD (5-aminosalicylic acid [5-ASA], glucocorticoids, immunosuppressive and biological agents) and a history of IBD-related gastrointestinal surgery. The UC patients were divided into four groups based on their disease severity according to their Mayo index classification: ≤2, remission; 3–5, mild activity; 6–10, moderate activity; and 11–12, severe activity. The CD patients were divided into three groups based on the severity of the disease defined by simplified CDAI: ≤4, remission; 5–8, moderate activity; and ≥9, severe activity.
Patients A total of 124 UC and 107 CD patients who were admitted to the Department of Gastroenterology or visited the IBD Clinic of Peking Union Medical College Hospital (Beijing, China) from June 2010 to March 2012 were recruited in the study. All patients were confirmed with IBD by experienced gastroenterologists based on the Chinese consensus on diagnosis and treatment standard of IBD.9 Exclusion criteria of the patients were: (i) patients aged
Journal of Digestive Diseases 2014; 15; 116–123
doi: 10.1111/1751-2980.12118
Original article
Vitamin D levels and bone metabolism in Chinese adult patients with inflammatory bowel disease Bei TAN,* Pan LI,*1 Hong LV,* Yue LI,* Ou WANG,† Xiao Ping XING† & Jia Ming QIAN* Departments of *Gastroenterology and †Endocrinology, Key Laboratory of Chinese Health Ministry, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
OBJECTIVE: We aimed to investigate the serum 25-hydroxyvitamin D3 (25[OH]D3) levels and bone metabolism in adult Chinese patients with inflammatory bowel disease (IBD) and to evaluate the correlation between vitamin D levels and the disease activity as well as the potential risk factors. METHODS: Age- and gender-matched cohort of IBD patients (124 with ulcerative colitis [UC] and 107 with Crohn’s disease [CD]) and 122 healthy controls were enrolled in this study. Serum levels of 25(OH)D3 and bone mineral density (BMD) were measured, and the correlation between the two parameters and the severity of the disease as well as the clinical risk factors were analyzed. RESULTS: Serum 25(OH)D3 levels were lower in UC (10.32 ± 4.46 ng/mL, P < 0.001) and CD patients (11.57 ± 5.02 ng/mL, P = 0.029) than that in
healthy controls (12.87 ± 4.40 ng/mL). 25(OH)D3 levels were negatively correlated with the disease severity of both UC (r = −0.371, P < 0.001) and CD (r = −0.285, P = 0.030). The incidences of osteopenia and osteoporosis were high in the IBD patients (37.9% and 3.2% in UC and 30.8% and 4.7% in CD, respectively). Cumulative quantity of glucocorticoids use was significantly associated with osteopenia and osteoporosis in both UC (odds ratio [OR] 1.219, 95% confidence interval [CI] 1.054−1.410, P = 0.008) and CD patients (OR 1.288, 95% CI 1.033−1.606, P = 0.025).
CONCLUSIONS: Vitamin D deficiency is likely to occur in Chinese patients with IBD and is closely associated with the severity of the disease. Glucocorticoids accumulation is a risk factor for osteopenia and osteoporosis.
KEY WORDS: bone mineral density, Crohn’s disease, inflammatory bowel disease, ulcerative colitis, vitamin D.
Correspondence to: Jia Ming QIAN, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. Email: [email protected] 1
Present address: Department of Gastroenterology, First Affiliated Hospital of Chongqing Medical University. Conflict of interest: None. © 2013 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd
116
INTRODUCTION Inflammatory bowel disease (IBD) is a group of diseases characterized by recurrent episodes of intestinal inflammation, including ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis. The etiology of IBD is complex, which includes genetic susceptibility of the hosts, environmental factors and abnormal mucosal immune responses to antigenic materials such as symbiotic bacteria in the gut. Vitamin D has been shown to have anti-inflammatory,
Journal of Digestive Diseases 2014; 15; 116–123 anti-cancer and immune regulatory effects, in addition to its traditional role of regulating calcium and phosphorus metabolism.1–5 Recently, the role of vitamin D in IBD is of increasing interest worldwide. Several retrospective studies, consisting of both referred and population-based cohorts from the Western hemisphere, reported that vitamin D deficiency was commonly observed in IBD patients and was independently related with the disease activity.6,7 Although seldom reported, the relationship among vitamin D levels, bone loss and IBD has been prospectively evaluated in a small sample of Chinese population.8 In this study, we aimed to investigate the serum vitamin D levels and bone metabolism in adult Chinese patients with IBD to determine the incidence of vitamin D deficiency, osteopenia and osteoporosis, and to evaluate the correlation between serum vitamin D levels and the severity of the disease as well as the potential risk factors. PATIENTS AND METHODS
Vitamin D and BMD in Chinese IBD patients
117
Demographic and clinical characteristics of the participants We collected the data on the participants’ age, gender, menstruation status in women and body mass index (BMI) as well as the following clinical characteristics: duration and clinical phenotype of the disease, location of the lesion, extent of UC, the Mayo index,9 the simplified CD activity index (CDAI) score,9 erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (hsCRP), bone metabolic markers (alkaline phosphatase [ALP], calcium and phosphorus), concurrent medications for IBD (5-aminosalicylic acid [5-ASA], glucocorticoids, immunosuppressive and biological agents) and a history of IBD-related gastrointestinal surgery. The UC patients were divided into four groups based on their disease severity according to their Mayo index classification: ≤2, remission; 3–5, mild activity; 6–10, moderate activity; and 11–12, severe activity. The CD patients were divided into three groups based on the severity of the disease defined by simplified CDAI: ≤4, remission; 5–8, moderate activity; and ≥9, severe activity.
Patients A total of 124 UC and 107 CD patients who were admitted to the Department of Gastroenterology or visited the IBD Clinic of Peking Union Medical College Hospital (Beijing, China) from June 2010 to March 2012 were recruited in the study. All patients were confirmed with IBD by experienced gastroenterologists based on the Chinese consensus on diagnosis and treatment standard of IBD.9 Exclusion criteria of the patients were: (i) patients aged
