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Increase of bone mineral density with sodium fluoride in patients with Crohn's disease.

Abstract

BACKGROUND AND AIMS

Low bone density with an increased risk of vertebral fractures is a frequent complication in inflammatory bowel disease. Since the aetiology of osteopathia in these patients is different compared to postmenopausal or steroid-induced osteoporosis, no treatment strategy is established. Supplementation of calcium and vitamin D has been shown to prevent further bone loss, but no data are available showing the anabolic effect of sodium fluoride in Crohn's disease.

METHODS

We carried out a one-year prospective clinical trial in 33 patients with chronic active Crohn's disease who were randomly assigned to receive either calcium (500 mg b.i.d.) and 1000 IU vitamin D3 only, or retarded-release sodium fluoride (25 mg t.i.d.) additionally. The diagnosis of Crohn's disease had been made at least two years ago, and all patients had received systemic high-dose steroid therapy during the previous year. Eleven of 15 patients who received calcium/vitamin D and 15 of 18 patients who additionally received sodium fluoride completed the study. The primary endpoint of the study was the increase of bone mineral density, measured by dual energy X-ray absorptiometry (DXA) after one year of treatment. Bone-specific alkaline phosphatase and osteocalcin were used as markers for bone turnover.

RESULTS

In the calcium/vitamin D only group, bone density was not significantly changed after one year of treatment, whereas in the calcium/vitamin D/fluoride group, bone density of the lumbar spine increased from -1.39+/-0.3 (Z-score, mean +/- SEM) to -0.65+/-0.3 (P<0.05) after one year of treatment. Increase of bone density was positively correlated to the osteoblastic markers bone-specific alkaline phosphatase (r = 0.53) and osteocalcin (r = 0.43).

CONCLUSIONS

Sodium fluoride in combination with vitamin D and calcium is an effective, well-tolerated and inexpensive treatment to increase lumbar bone density in patients with chronic active Crohn's disease and osteoporosis.

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  • Authors+Show Affiliations

    ,

    Department of Medicine I, University of Ulm, Germany.

    , , , , , ,

    Source

    MeSH

    Adult
    Bone Density
    Calcium
    Cholecalciferol
    Crohn Disease
    Drug Therapy, Combination
    Female
    Humans
    Male
    Osteoporosis
    Prospective Studies
    Sodium Fluoride

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    10656205

    Citation

    von Tirpitz, C, et al. "Increase of Bone Mineral Density With Sodium Fluoride in Patients With Crohn's Disease." European Journal of Gastroenterology & Hepatology, vol. 12, no. 1, 2000, pp. 19-24.
    von Tirpitz C, Klaus J, Brückel J, et al. Increase of bone mineral density with sodium fluoride in patients with Crohn's disease. Eur J Gastroenterol Hepatol. 2000;12(1):19-24.
    von Tirpitz, C., Klaus, J., Brückel, J., Rieber, A., Scholer, A., Adler, G., ... Reinshagen, M. (2000). Increase of bone mineral density with sodium fluoride in patients with Crohn's disease. European Journal of Gastroenterology & Hepatology, 12(1), pp. 19-24.
    von Tirpitz C, et al. Increase of Bone Mineral Density With Sodium Fluoride in Patients With Crohn's Disease. Eur J Gastroenterol Hepatol. 2000;12(1):19-24. PubMed PMID: 10656205.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Increase of bone mineral density with sodium fluoride in patients with Crohn's disease. AU - von Tirpitz,C, AU - Klaus,J, AU - Brückel,J, AU - Rieber,A, AU - Scholer,A, AU - Adler,G, AU - Böhm,B O, AU - Reinshagen,M, PY - 2000/2/3/pubmed PY - 2000/5/8/medline PY - 2000/2/3/entrez SP - 19 EP - 24 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 12 IS - 1 N2 - BACKGROUND AND AIMS: Low bone density with an increased risk of vertebral fractures is a frequent complication in inflammatory bowel disease. Since the aetiology of osteopathia in these patients is different compared to postmenopausal or steroid-induced osteoporosis, no treatment strategy is established. Supplementation of calcium and vitamin D has been shown to prevent further bone loss, but no data are available showing the anabolic effect of sodium fluoride in Crohn's disease. METHODS: We carried out a one-year prospective clinical trial in 33 patients with chronic active Crohn's disease who were randomly assigned to receive either calcium (500 mg b.i.d.) and 1000 IU vitamin D3 only, or retarded-release sodium fluoride (25 mg t.i.d.) additionally. The diagnosis of Crohn's disease had been made at least two years ago, and all patients had received systemic high-dose steroid therapy during the previous year. Eleven of 15 patients who received calcium/vitamin D and 15 of 18 patients who additionally received sodium fluoride completed the study. The primary endpoint of the study was the increase of bone mineral density, measured by dual energy X-ray absorptiometry (DXA) after one year of treatment. Bone-specific alkaline phosphatase and osteocalcin were used as markers for bone turnover. RESULTS: In the calcium/vitamin D only group, bone density was not significantly changed after one year of treatment, whereas in the calcium/vitamin D/fluoride group, bone density of the lumbar spine increased from -1.39+/-0.3 (Z-score, mean +/- SEM) to -0.65+/-0.3 (P<0.05) after one year of treatment. Increase of bone density was positively correlated to the osteoblastic markers bone-specific alkaline phosphatase (r = 0.53) and osteocalcin (r = 0.43). CONCLUSIONS: Sodium fluoride in combination with vitamin D and calcium is an effective, well-tolerated and inexpensive treatment to increase lumbar bone density in patients with chronic active Crohn's disease and osteoporosis. SN - 0954-691X UR - https://www.unboundmedicine.com/medline/citation/10656205/Increase_of_bone_mineral_density_with_sodium_fluoride_in_patients_with_Crohn's_disease_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=10656205.ui DB - PRIME DP - Unbound Medicine ER -