T1122
Risedronate Protects Against Bone Loss When a Relapse of IBD Is Treated with Steroids
Muhammed H Kriel¹, Jonathan H Tobias¹, Tom J Creed², Melanie J Lockett³, Andrew J Bell⁵, John D Linehan⁴, Christopher S Probert¹
1. Department of Clinical Sciences at South Bristol, University of Bristol, Bristol, United Kingdom, 2. Department of Gastroenterolgy, Bristol Royal Infirmary, Bristol, United Kingdom, 3. Department of Medicine, Frenchay Hospital, North Bristol NHS Trust, Bristol, United Kingdom, 4. Department of Medicine, Royal United Hospital, Bath, United Kingdom, 5. Department of Medicine, Weston-Super-Mare General Hospital, Weston-Super-Mare, United Kingdom

The management of IBD has many challenges not least that of complications associated with treatment. Bone loss in the context of IBD is well described; corticosteroid use being one of its major determinants. Various organizations have recommended treatment strategies for bone loss when steroids are being used, including bisphosphonates. However this approach has not been investigated in the context of steroid therapy for exacerbations of IBD. Our group has shown rapid bone loss in Crohn's disease (CD), especially at the hip, during a standard 8 week course of prednisolone for a disease flare up. This leaves potentially young patients vulnerable to fracture. In order to determine whether the use of a bisphosphonate will prevent bone loss over a course of 2 months of steroid treatment, we recruited patients who were about to start prednisolone for a flare of their IBD. These patients were randomized to receive either placebo or Risedronate therapy. All the patients received a calcium and vitamin D supplement. After giving written informed consent, participants had a baseline DXA scan and a 2nd DXA 8 weeks later. The lumbar spine (LS) and both hips were scanned each time. 84 patients were recruited and 73 (42 ulcerative colitis and 31 CD) patients returned for a 2nd scan per protocol. Protocol violations included non compliance with the trial medication (4), failure to wean off steroids (2) or colectomy in 1 case. Of those completing the study, the mean age was 43.5 y (19-73) and 42 patients were male. The table shows mean BMD at each site at each scan. For each treatment group, the BMD on each occasion was compared using a paired T-test. Per protocol data are shown, intention to treat findings were similar. Risedronate once weekly therapy was associated with a gain in BMD in the lumbar spine. In contrast, an average of 2% loss of BMD was found in Ward’s triangle among patients who only received calcium and vitamin D; Risedronate reduced this. These data are the first to demonstrate a protective effect of Risedronate in patients receiving a 2 month course of steroid therapy for relapse of IBD.

Mean BMD and percentage change from baseline to 2 months

	Lumbar spine				Total hip				Ward’s triangle
Scan	1st	2nd	Change	p value	1st	2nd	Change	p value	1st	2nd	Change	p value
Risedronate group	1.16	1.17	1% gain	0.03	1.03	1.03	0	ns	0.85	0.85	1% loss	ns
Placebo group	1.14	1.14	0	ns	1.00	1.00	0	ns	0.81	0.80	2% loss	0.0002