Bone Mineral Density and Bone Remodeling in Tunisian Patients with Inflammatory Bowel Disease

Samar Ben Jemaa1, *, Lassaad Chtourou2, Rim Akrout1, Khansa Chaabouni3, Tarek Chaabouni3, Hela Makni Fourati1, Ali Amouri2, Nabil Tahri2, Fatma Ayedi3, Sofien Baklouti1
1 Department of Rhumatology, Hedi Chaker University Hospital, Sfax, PC: 3089, Tunisia
2 Department of Gastroenterology and Hepatology, Hedi Chaker University Hospital, Sfax, Tunisia
3 Laboratory of Biochemistry, Habib Bourguiba University Hospital, Sfax, Tunisia



A high prevalence of osteopenia and osteoporosis is observed in patients with inflammatory bowel disease (IBD).


The aim of our study was to investigate the prevalence of bone loss, bone remodeling and risk factors in Tunisian patient with IBD.

Patients and Methods:

The study included 40 patients with IBD and 32 age- and sex-matched healthy controls subjects. All participants underwent bone densitometry by dual energy X-ray absorptiometry at the femoral neck and lumbar spine. Serum levels of 25-hydroxy vitamin D (25(OH)D), parathyroid hormone (PTH), osteocalcin(OC), and urinary degradation products of C-terminal telopeptide of type I collagen (CTXI) were measured in all participants to assess the bone metabolism status.


Twelve (30%) patients were normal, 32.5% were osteopenic and 37.5% were osteoporotic. Osteoporosis was more frequent in IBD patients than controls (p=0.0001). Age and inflammation were associated with low bone mineral density (BMD). Mean calcium, phosphorus and alkaline phosphatase levels were similar in both groups. Median 25(OH) D levels were significantly lower in IBD patients compared with controls (p=0.0001). Median urinary CTXI levels were significantly higher in IBD patients compared with healthy controls (p=0.007). No significant differences between IBD patients and controls concerning the median serum OC and PTH levels were found.


In our study, there is a high prevalence of low BMD in IBD patients and an increase in bone resorption without a change of bone formation. Low BMI and hypovitaminoses D were identified as risk factors for low BMD.

Keywords: Inflammatory bowel disease, Osteopenia, Osteoporosis, Hypovitaminosis D, Bone mineral density, Bone remodeling.

Abstract Information

Identifiers and Pagination:

Year: 2018
Volume: 12
Publisher Item Identifier: EA-TOTJ-2018-20

Article History:

Received Date: 27/6/2018
Revision Received Date: 31/10/2018
Acceptance Date: 23/11/2018
Electronic publication date: 5/12/2018
Collection year: 2018

© 2018 Ben Jemaa et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: Address correspondence to this author at the Department of Rhumatology, Hedi Chaker University Hospital, Sfax, PC: 3089, Tunisia; Tel: 23733004; E-mail: