Bone Score Tied to Bone Quality in People with Inflammatory Bowel Disease

young pretty girl on examination in a modern clinic by densitometry – checking the density of bone tissue.
A common complication in people with inflammatory bowel disease is bone disorders, including osteoporosis and osteopenia, regardless of the person’s age. Researchers in Bucharest looked at ways to access bone impairment in people with inflammatory bowel disease through diagnostic testing.

Trabecular bone score (TBS), a noninvasive measure of lumbar spine dual-energy x-ray absorptiometry (DXA), and bone mineral density (BMD) tests could be early predictors of skeletal strength and fracture risk in those with inflammatory bowel disease (IBD), according to research findings published in Scientific Reports.

In the study, the researchers also found that patients with IBD may have lower DXA parameters than healthy patients, underscoring the need for routine assessment of bone quality in this patient population.

The cross-sectional study enrolled 81 patients with IBD, including 48 patients with Crohn disease (CD) (median age, 42 years; median disease duration, 8 years) and 33 patients with ulcerative colitis (UC) (median age, 44 years; median disease duration, 10.3 years). Another 81 healthy controls matched to the IBD group by age, body mass index, and sex were included.

Investigators took blood tests, performed DXA, and assessed the TBS for all participants. To evaluate clinical disease activity in the IBD group, the researchers used the Harvey–Bradshaw Index (HBI) for CD and the Partial Mayo Scoring Index (PMSI) for UC. The HBI includes assessments of general well-being, abdominal pain, frequency of liquid bowel movements, abdominal mass, and complications. In contrast, the PMSI includes assessments of stool frequency, rectal bleeding, and Physician’s Global Assessment score.

At baseline, the median HBI score was 3 for patients with CD, while the median PMSI score was 2 in the UC group. The majority of patients with IBD had 2 to 4 previous treatment courses with high-dose glucocorticoids (n=28) or >4 previous courses of high-dose glucocorticoids (n=23).

Patients with IBD had significantly lower lumbar spine BMD compared with healthy controls (1.06±0.18 vs 1.16±0.15 g/cm2, respectively; P <.005). Additionally, patients with IBD also had significantly lower values for hip BMD (0.88±0.13 vs 0.97±0.13 g/cm2; P <.005) and TBS (1.38±0.1 vs 1.43±0.1; P <.005).

Compared with patients with nonstricturing CD, those with stricturing CD had lower values for TBS (1.32±0.13 vs 1.40±0.9; P =.03) and lumbar spine BMD (0.92±0.19 vs 1.07±0.1; P =.01).

In a multivariate regression model analysis, HBI was the only independent factor associated with TBS (unstandardized coefficient, −0.094; 95% CI, −0.183 to −0.005; P =.03).

Limitations of the study included the small number of patients with fragility fractures, which did not allow researchers to evaluate whether TBS could be a good predictive parameter. Additionally, the study included mostly patients with vitamin D levels classified as insufficient and deficient, which the investigators explained could have influenced the TBS findings.

“Further prospective studies should be conducted with prospective follow-up of TBS changes in comparison with BMD changes during different stages of the disease and after vitamin D supplementation,” the researchers wrote.


Soare I, Sirbu A, Martin S, et al. Assessment of bone quality with trabecular bone score in patients with inflammatory bowel disease. Sci Rep. 2021;11:20345. doi:10.1038/s41598-021-99669-z