Strategies to promote bone health in people with Inflammatory Bowel Disease

Jan 10, 2013

Quick Bites:

To protect and promote bone health, people with IBD should eat a diet rich in calcium and vitamin D and participate in an appropriate exercise program. Not smoking and avoiding excessive use of alcohol are also important. In some cases, medication to prevent further bone loss may be recommended, especially for those on long-term glucocorticoid therapy.

Nutrition: A well-balanced diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Supplements can help ensure that you get adequate amounts of calcium each day, especially in people with a proven milk allergy. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for adults, increasing to 1,200 mg for those age 50 and older.

Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. Although many people obtain enough vitamin D by getting about 15 minutes of sunlight exposure each day, others, especially those who are older or housebound – may need vitamin D supplements to achieve the recommended intake of 400 to 600 IU (International Units) each day.

Exercise: Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best activity for your bones is weight-bearing exercise that forces one to work against gravity. Some examples include walking, climbing stairs, dancing, and weight training. These and other types of exercise also strengthen muscles that support bone, enhance balance and flexibility, and preserve joint mobility, all of which help reduce the likelihood of falling and breaking a bone, especially among older people.

Healthy lifestyle: Smoking is bad for bones as well as the heart and lungs. Women who smoke tend to go through menopause earlier, resulting in earlier reduction in levels of the bone-preserving hormone estrogen and triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol also can have a negative effect on bone health. Those who drink heavily are more prone to bone loss and fracture, because of both poor nutrition and increased risk of falling.

Bone density test: A bone mineral density (BMD) test measures bone density in various parts of the body. This safe and painless test can detect osteoporosis before a fracture occurs and can predict one’s chances of fracturing in the future. Adults with IBD should talk to their doctors about whether they might be candidates for a BMD test. This test can help determine whether medication should be considered and can be used to monitor the effects of an osteoporosis treatment program.

Medication: Like Crohn’s disease and ulcerative colitis, osteoporosis is a disease with no cure. However, several medications are available for the prevention and/or treatment of osteoporosis, including: bisphosphonates; estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMS); parathyroid hormone; estrogen therapy; hormone therapy; and a recently approved RANK ligand (RANKL) inhibitor.