Background/Purpose: Intestinal Bowel Diseases (IBD), including Crohn’s (ChD), and Ulcerative Colitis (UCD), along with Celiac (ClD), diseases are chronic inflammatory conditions that primarily affect the gastrointestinal tract with systemic complications such as compromised bone health. These disorders are frequently associated with malabsorption of essential nutrients critical for bone metabolism. Chronic inflammation further exacerbates bone loss by promoting osteoclast activation and impairing osteoblast function through elevated levels of pro-inflammatory cytokines leading to higher prevalence of osteopenia, osteoporosis, and fragility fractures, even at a younger age. Additionally, long-term corticosteroid therapy contributes to reduced BMD and increased fracture risk Understanding the interplay between intestinal immune activity and skeletal health is essential for effective prevention and monitoring strategies. This study primary aims to assess the innovative 5-year fracture risk (FR) in these patients using the Radiofrequency Echographic Multi-spectrometry (REMS) technology and, secondarily, determine which condition has the greatest impact on fracture risk.

Methods: The 5-year FR was assessed using a REMS-based algorithm that automatically integrates both quantity and quality parameters. Specifically, by combining the REMS T-score with the Fragility Score (FS), the system identifies 7 distinct risk categories, each corresponding to a progressively increasing probability of fracture. To ascertain the impact of each pathology on the likelihood of experiencing an incident fracture, a logistic regression was performed.

Results: A cohort of 63 Caucasian patients (both genders), with ChD (n = 19, median age: 61 yo, 42.1% women < 65 yo), ClD (n = 38, median age: 47.8 yo, 73.7% women < 65 yo), and UCD (n = 6, median age: 71 yo, 25% women < 65 yo) diseases underwent REMS scans at femoral neck. The FR analysis on hips showed that in ChD and UCD patients were mostly classified into high-risk classes (R5-R7), as follows: 21.1% (R5), 10.5% (R6), and 21.1% (R7), and 33.3% (R5 and R7), respectively. Conversely, in ClD, patients were never classified in the high-risk level: R1 (23.7%), R3 (44.7%), and R4 (5.3%)). The logistic regression revealed a strong and statistically significant association between IBD and ClD and high-risk fracture, with UCD OR = 5.5 (95% CI = 5.5, p < 0.001), followed by ChD (OR = 3.1% CI = 3.1-3.1, p < 0.0001) and by ClD (OR = 1.3, 95% CI = 1.3-1.3, p < 0.0001) groups. Notably, the FS was higher in the IBD patients compared to ClD group (42.51 and 29.2 for ChD and UCD, respectively), thus supporting the hypothesis that a steroids-based therapy in these patients can negatively affect the trabecular architecture.

Conclusion: This study highlights a significant link between these conditions and increased fracture risk, with UCD having the greatest impact, followed by ChD, while ClD posed a comparatively lower risk. Furthermore, these findings emphasize the importance of early, targeted monitoring of bone health in these patients. The integration of bone quantity and quality parameters could enhance fracture risk prediction and support cost-effective strategies to prevent osteoporotic fractures in USA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fracture-risk-in-intestinal-autoimmune-mediated-diseases-patients-clinical-insights-from-rems/