ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026
Increased osteoporosis burden and comparative antiresorptive effectiveness in inflammatory bowel disease: a real-world cohort study.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Contemporary IBD care lacks precise osteoporosis risk estimates and data on comparative therapy. In U.S., IBD patients had a 56% higher 5-year risk of a new osteoporosis diagnosis (highest in Crohn's disease); denosumab matched bisphosphonates for 1-2-year fracture prevention in this population. Our study prioritizes early screening, steroid-sparing strategies, and individualized antiresorptive therapy.
backgroundOsteoporosis is a frequent extra-intestinal complication of inflammatory bowel disease (IBD), yet its current burden and the comparative efficacy of available anti-resorptive therapies remain uncertain.
methodsUsing the US TriNetX network we formed two retrospective cohorts. (1) Adults with IBD (2013-2023) were 1:1 propensity-matched to non-IBD controls to estimate 5-year risk of new osteoporosis diagnosis and identify determinants. (2) IBD patients with osteoporosis initiating denosumab or bisphosphonates (2013-2022) were matched for demographics, comorbidities, and IBD phenotype; spine/hip fractures and risk for incident onset fractures were calculated for both the cohorts.
resultsAmong 143,248 patients with IBD (mean age 44.2 y; 51.8% female), risk of new osteoporosis diagnosis exceeded controls by 58% at 1 year (adjusted odds ratio [aOR] 1.58, 95% CI 1.51-1.65) and was highest in Crohn's disease (CD) (aOR 1.79, 95% CI 1.68-1.90); ulcerative colitis (UC) also demonstrated increased 1-year risk (aOR 1.47, 95% CI 1.39-1.56). Subgroup analysis showed increased risk in patients age > 65, female sex and Asian race for UC. For CD, age > 65, female sex, nicotine dependence and alcohol use were associated with increased risk. The osteoporosis treatment cohort included 2,423 patients (520 denosumab and 1,903 bisphosphonates). After matching, denosumab produced similar 1-year (2.33% vs 3.49%, aOR 0.65 CI 0.31-1.38) and 2-year (4.65% vs 6.78%; aOR 0.67, CI: 0.39-1.14) fracture rates compared to bisphosphonates.
conclusionIBD confers a substantially higher and multifactorial osteoporosis risk. Denosumab showed similar observed short-term fracture rates to bisphosphonates, although clinically meaningful differences could not be excluded. Early bone-health screening, steroid-sparing therapy, and individualized antiresorptive treatment remain essential.
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