Source: Cancer  |  Posted 9 years ago

Ibandronate and sodium fluoride both appear to be effective in combination management of osteopaenia and osteoporosis of postmenopausal women with Crohn's disease.

Both of the agents induce continuous increases in lumbar bone density in a combination with calcium and vitamin D substitution, report Dr C Von Tirpitz and colleagues at the University of Ulm, Ulm, and Philipps-University, Marburg, Germany.

Osteoporosis is a frequent complication in Crohn's disease, the investigators note. Both sodium fluoride and amino-bisphosphonates have been studied in long-term therapy among postmenopausal women with osteoporosis. However, there have been no long term study results on what effect these two agents might have in the management of osteoporosis in patients with Crohn's disease.

Initially, the investigators enrolled 84 patients with Crohn's disease and pathological bone mineral density findings. In addition to daily calcium/vitamin D substitution, one group was randomly assigned to receive either vitamin D3 (1000 IU) and calcium citrate (800 mg) daily (group A), or sodium fluoride (25 mg bd, group B) or intravenous ibandronate (1 mg every three months, group C). The patients underwent dual-energy X-ray absorptiometry and radiological examination of the spine at baseline, and at 12 and 27 months.

Overall, 68 patients completed the 12-month observation period and were available for the intention-to-treat analysis. No new vertebral fractures were diagnosed among the cohort.

The investigators found that in group A, lumbar bone density increased by 2.6%, in group B by 5.7%, and in group C by 5.4%. Therapy with sodium fluoride was associated with an increase in osteocalcin, which was not significant, while the use of ibandronate was associated with a decrease in the resorption parameter, carboxy-terminal cross-linked type-I collagen telopeptide.

The use of both sodium fluoride and ibandronate resulted in significant decreases in the serum concentration of osteoprotegerin after nine months.