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Predictors of risk of fracture in inflammatory bowel diseases: a prospective study using FRAX score

Ribaldone DG1Procopio M2Pellicano R3Barale M2Giudici G4Morino M5Saracco GM4Astegiano M3.

Minerva Gastroenterol Dietol. 2020 Mar 24. doi: 10.23736/S1121-421X.20.02672-0. [Epub ahead of print]




Despite the well-known risk of osteoporosis and bone fractures among patients with inflammatory bowel diseases, the WHO FRAX tool has been used in a limited number of studies in this specific population. The purpose of this study was to search for predictors of risk of fractures assessed by FRAX score.


We prospectively calculated FRAX score for hip and major osteoporotic fractures in inflammatory bowel disease patients consecutively recruited.


The mean risk of hip fractures at 10 years, for the 80 recruited patients, resulted 1.4%, while the mean risk of major osteoporotic fractures was 7.8%. The risk of hip fractures was 1.3% among the 30 Crohn’s disease patients versus 1.4% (p = 0.82) among 50 ulcerative colitis patients. A prolonged use of corticosteroids correlated with a tendency to a greater risk of hip fracture (r = 0.38, p = 0.08). Patients with normal erythrocyte sedimentation rate (ESR) values had a risk of osteoporotic hip fractures of 0.75%, while those with high ESR values had a risk of 1.86% (p = 0.04). Regarding the risk of major bone fractures, patients with normal ESR values had a risk of 5.9%, versus a risk of 18% in those with elevated ESR (p = 0.03).


The correlation between increase of inflammatory markers and increased risk of osteoporotic fractures and the lack of difference between Crohn’s disease and ulcerative colitis suggest a central role of inflammation over malabsorption in this population.