engleski

Prevalent hypovitaminosis D in Crohns disease correlates highly with mediators of osteoimmunology.

Purpose In the context of osteoimmunology in Crohn's disease, an association was hypothesized among vitamin D and members of the TNF-α family, known as the RANK (receptor-activator of nuclear factor- B)-RANK ligand-osteoprotegerin pathway. Patients and Methods This was a cross-sectional study of 95 patients with Crohn’s disease (80 with long-standing disease and 15 newly diagnosed, never treated), and two control groups: healthy volunteers (n=30) and ulcerative colitis patients (n=30). Spine and hip bone mineral density was measured by dual- energy x-ray absorptiometry. Serum 25- hydroxyvitamin-D3, TNF-α, IL-6, sRANKL, osteoprotegerin, and biochemical markers of bone turnover were analyzed. Results The precursor metabolite, 25(OH)D3 was measured in 95 young adult CD patients (47 men, 48 women ; median age 30 years). A suboptimal 25(OH)D3 level was observed in 90% of CD patients ; of whom 40% had a serious deficiency. There was no significant difference in 25(OH)D3 levels between CD patients and those with ulcerative colitis. Analysis revealed an association between the increased biogenesis of osteoclastically active sRANKL (p=0.014) and proinflammatory TNF-α (p=0.015) and IL-6 (p=0.029) with 25(OH)D3 deficiency. This relationship was inversely significant. CD patients with low bone mineral density had a mean 25(OH)D3 (35±18 nmol/l) in the range of serious deficiency to insufficiency, whereas this was higher (49±28 nmol/l) in patients with healthy bone status, though still within the range of inadequate levels (p=0.004). The logistic model reported low 25(OH)D3 to be a significant predictor of bone disease [odds ratio=2.66(6.8), p<0.009]. In the multivariable analysis adjusted for several confounding factors, 25(OH)D3 together with sRANKL, IL-6 and TNF-α were independently associated with a likelihood of bone disease [odds ratio (range): 1.02(2.75) ; 1.09(3.71) ; 1.27(6.95) respectively, p=0.001]. Conclusion The presented findings suggest that 25(OH)D3 deficiency accompanying an inflammatory state in Crohn's disease is a high risk condition for metabolic bone disease.

osteoimmunology; vitamin D; receptor activator of nuclear factor B-ligand; proinflammatory cytokines; metabolic bone disease; Crohn's disease

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