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Nutrients in the Prevention of Osteoporosis in Patients With Inflammatory Bowel Diseases

Alicja Ewa Ratajczak 1Anna Maria Rychter 1Agnieszka Zawada 1Agnieszka Dobrowolska 1Iwona Krela-Kaźmierczak 1

Nutrients. 2020 Jun 6;12(6):E1702. doi: 10.3390/nu12061702.

Abstract

The chronic character of inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium and vitamin D are the most often discussed nutrients with regard to bone mineral density. Moreover, vitamins A, K, C, B12; folic acid; calcium; phosphorus; magnesium; sodium; zinc; copper; and selenium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals and vitamins or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. Thus, nutritional guidelines for inflammatory bowel disease patients should comprise information concerning the prevention of osteoporosis.

Conclusions

The diet of IBD patients often proves to be inadequate, which a
ects the peak bone mass, thus leading to osteopenia, osteoporosis, and fractures. Nutrition guidelines for IBD patients should include osteoporosis prevention.

In conclusion, it is worth emphasizing that:

1. The vitamin D concentration in patients with IBD should be examined routinely, since IBD constitutes a risk factor of vitamin D deficiency. Individual doses of vitamin D are recommended.

2. Most IBD patients require calcium supplementation (1000–1500 mg/day).

3. We recommend the assessment of the fruit and vegetable intake in IBD patients. In patients with low BMD and a simultaneous inadequate consumption of fruits and vegetables, vitamin C supplementation may be considered.

4. Vitamin B12 and folic acid supplementationmay be introduced in patientswith hyperhomocysteinemia, since a high level of homocysteine correlates with a low bone mineral density.

5. Vitamin A supplementation is not recommended. A high level of this vitamin may have a negative influence on bone health.

There are no cient data to recommend the supplementation of vitamin K, magnesium, zinc,

copper, and selenium in IBD patients for the prevention of osteoporosis.

7. IBD patients consume less sodium than the rest of the population, in particular the malnourished patients. On the other hand, sodium intake in developed countries is higher than recommended, and a high dose of Na correlates with a low BMD. Therefore, it is not necessary to encourage patients to use more salt.

8. Polyphenols may be beneficial for patients’ health; thus, they should be included in the diet in the form of herbs, fruits, or vegetables.

The importance of diet in the prevention of osteoporosis in the group of patients with IBD is indisputable. Hence, it is vital to adhere to the recommendations of a clinical dietitian, as an important member of the coordinated IBD patient care team.