P055 - the ACCESS Trial: Impact of Adalimumab on Remission, Response and Quality of Life in Patients with Crohn's Disease

Aim: Although Crohn's disease (CD) is known to be associated with osteoporosis, the mechanisms through which this association is established remain to be unravelled.This study aims to assess factors that may increase the risk of osteoporosis in patients with CD. Materials and Methods: Retrospective study including 69 patients with CD (27 male, 42 female, mean age 41±14.4years).The prevalence of both osteoporosis and osteopenia was determined collecting data from osteodensitometry analysis.Potential causes for metabolic bone disease were sought: disease duration and activity, small bowel involvement, need for surgery, corticosteroid use, physical activity, smoking habits, Body Mass Index (BMI), dietary intake of calcium, D and K vitamins, and genetic polymorphisms for pro-and antiinflammatory cytokines.Results: Based on WHO T-score criteria, 17% (12) of patients had osteoporosis, 45% (31) had osteopenia and 38% (26) had a normal T-score value.Considering osteoporosis as the negative outcome, we found that its risk was associated with longer disease duration (OR = 4.7; 95% CI 1.2 17.7; p = 0.02) and marginally with a higher disease activity (OR = 3.3; 95% CI 0.9 11.8; p = 0.06).In contrast, less need for surgery had a protective effect for osteoporosis (OR = 0.26; 95% CI 0.06 1.06; p = 0.05).No significant association was found with previous corticosteroid use, with dietary intakes of calcium, vitamins D and K, small bowel involvement, smoking habits, physical activity or BMI.The presence of polymorphic variants for two pro-inflammatory cytokines: LTA252 (AG/GG) and LTA80 (CA/AA) was also found to be associated with an increased risk for osteoporosis (OR = 6.0; 95% CI 1.1 32.9 p = 0.03 and OR = 7.3; 95% CI 0.8 64.4; p = 0.04 respectively).Moreover, the polymorphism VNTR (86bp) for the anti-inflammatory cytokine IL1Ra showed a protective effect for osteoporosis (OR = 0.2; 95% CI 0.01 1.1; p = 0.03).In contrast, the risk of osteopenia was not associated with any of the clinical variables analysed nor with any of the genetic polymorphisms studied.Conclusions: This study confirms a high prevalence of both osteoporosis and osteopenia in patients with CD.The risk for osteoporosis seems to be influenced by disease severity and duration, especially in genetically susceptible subjects with specific cytokine expression profile.In contrast, the clinical significance of osteopenia remains unclear and further prospective studies are needed to clarify whether this condition may increase the risk of later osteoporosis.