A Bone to Pick with IBS

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Irritable bowel syndrome patients more likely to develop osteoporosis and fractures

May 7, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD

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(dailyRx News) With certain stomach and intestinal tract conditions, weak bones can result. The same holds true for patients with abnormal bowel movements.

Irritable bowel syndrome (IBS) patients were more than four times as likely to develop osteoporosis and related fractures as individuals without the condition, a recently published study found.

The researchers advised patients diagnosed with the gastrointestinal condition to undergo screening measures to identify osteoporosis and prevent fractures from happening.

"Seek treatment to prevent osteoporosis."

Previous research established that patients with Crohn's disease, ulcerative colitis and celiac disease, all which involve the gastrointestinal tract, have an increased risk for osteoporosis and fractures related to the condition.

Research led by Derrick Stobaugh, BS, research study coordinator in the Department of Gastroenterology at NorthShore University Health System, investigated whether patients with IBS are also at an increased risk for osteoporosis.

The study involved 317,857 emergency department visits identified using the Nationwide Emergency Department Samples in which patients were diagnosed with IBS.

Patients with IBS experience abdominal pain, bloating and gas. More severe cases can have different bowel movement patterns.

The researchers measured patients' odds of having osteoporosis, as well as fractures along the wrist, spine, hip and femur or thighbone.

Of the patients identified with IBS, 17,752 were diagnosed with osteoporosis and 694 had had a concurrent fracture on their wrist, hip or spine caused by their condition.

Another 1,503 patients had fractures along the same areas caused by a traumatic incident.

The researchers found that patients with IBS were more than four times as likely to develop osteoporosis compared to individuals without the condition.

Further, IBS patients had a two-fold risk of sustaining fractures compared to non-IBS patients. The wrist was the likeliest place to fracture.

"Our study suggests that a history of IBS may be associated with the development of osteoporosis," the researchers wrote in their report. "The adjusted odds ratio for this in patients with IBS is higher than those with ulcerative colitis and Crohn's disease but lower than in patients with celiac disease. Patients with IBS also have higher adjusted odds for fractures associated with osteoporosis."

According to Steven Kussin, MD, former assistant professor of clinical medicine at Albert Einstein College of Medicine and Columbia Presbyterian and founder Shared Decision Center in New York, the findings and recommendations are badly overstated.

"It would be premature to advise routine monitoring of bone mineral density and serum levels of vitamin D in  women 40 years old with IBS," Dr. Kussin said. "Screening this population is premature in view of the lack of evidence of effective bone-protective treatments in this age group."

He said that diagnosis of osteoporosis is fraught with controversies regarding over diagnosis, including those over age 65.

"This is particularly clear in light of the fact that there are no proven biological reasons IBS patients are susceptible to osteoporosis and osteoporotic fractures," Dr. Kussin said. "ER discharge diagnoses upon which this study is based are historically inaccurate. IBS is known to be incorrectly coded, over diagnosed and misdiagnosed."

The researchers noted they are not sure how the medications affected the fragility of the fractures and the risk of osteoporosis in the elderly population.

The data researchers used also might have underestimated the actual odds of developing osteoporosis and fractures related to IBS. And doctors may have diagnosed the conditions differently.

The study was published in the April 2013 issue of the Osteoporosis International. No conflicts of interest were reported.