Practices And Attitudes Toward The Metabolic Bone Disease In Inflammatory Bowel Disease

Objective:Osteoporosis is common in patients with inflammatory bowel diseases(IBD)such as Crohn’s disease(CD)or ulcerative colitis(UC).Nowadays the incidence and prevalence of Chinese IBD are increasing rapidly,so osteoporosis of these patients requires greater attention.In this study,we investigated Chinese gastroenterologists’ knowledge regarding Osteoporosis patients with IBD and defined the gastroenterologist’s role in the treatment of Osteoporosis in IBD.Moreover the results will help inform which elements of Osteoporosis require increased attention by academic and professional institutions.Methods:Online questionnaires were sent to gastroenterologists in secondary and tertiary hospitals in China via message and email.The survey included multiple choices and the Likert scale questions,investigating the clinician’s practices and attitudes toward the metabolic bone disease in inflammatory bowel disease.Results:Three hundred and seventeen gastroenterologists completed the questionnaire.The vast majority(83.0%,263/317)came from the tertiary hospital with the remainder working at the secondary hospital.Most gastroenterologists(67.2%,213/317)agreed or strongly agreed with that osteoporosis is common in patients with IBD.Almost all gastroenterologists chose malnutrition(310/317,97.8%)as the lifestyle leading to bone loss and osteoporosis,followed by physical inactivity(261/317,82.3%)and excessive alcohol(208/317,65.6%),smoking(171 / 317,53.9%).Hypogonadism(33.4%)and low body mass index(39.4%)were not considered by most physicians as risk factors for osteoporosis.Most gastroenterologists(91.48%,290/317)knew that Bone mineral density(BMD)in the patients with IBD often measured by dual-energy x-ray absorptiometry(DXA).66.88% said that they are familiar with the clinical evaluation of osteoporosis,48.26% would regularly monitor bone mineral density in IBD patients with osteoporosis.Practices and attitudes of treatment regimens for patients with osteoporosis in IBD were investigated.The first three treatments are calcium and vitamin D(98.74%-96.21%,P=0.011),lifestyle(89.91%-83.60%,P<0.001)and enteral nutrition(81.07%-71.92%,P<0.001),about half of the choice of bisphosphonate treatment(61.20%-41.01%,P<0.001),less treatment options are gonadal steroid replacement(31.86%-18.30%,P<0.001)and calcitonin(35.96%-25.24%,P<0.001).Conclusion: Chinese gastroenterologists have primary knowledge and experience in the understanding,diagnosis and treatment of the metabolic bone disease in inflammatory bowel disease,but they are not comprehensive enough.Chinese gastroenterologists are more concerned about the nutritional assessment of patients with IBD,but lack sufficient knowledge of some risk factors,disease assessment,follow-up monitoring and some drug use experience.Doctors generally believe that most patients with IBD who have metabolic bone disease lack specialist treatment.Therefore,it is necessary to establish a consensus on the diagnosis as well as treatment and strengthen multidisciplinary cooperation,in order to ensure that patients with IBD suffering from metabolic bone disease receive accurate diagnosis and timely and adequate treatment.