Increase of bone mineral density with sodium fluoride in patients with Crohn's disease

Background and aims Low bone density with an increased risk of vertebral fr actures is a frequent complication in inflammatory bowel disease. Since the aetiology of osteopathia in these patients is different compared to postme nopausal or steroid-induced osteoporosis, no treatment strategy is establis hed. Supplementation of calcium and vitamin D has been shown to prevent fur ther bone loss, but no data are available showing the anabolic effect of so dium fluoride in Crohn's disease. Methods We carried out a one-year prospective clinical trial in 33 patients with chronic active Crohn's disease who were randomly assigned to receive either calcium (500 mg b.i.d.) and 1000 IU vitamin Dg only, or retarded-rel ease sodium fluoride (25 mg t.i.d,) additionally. The diagnosis of Crohn's disease had been made at least two years ago, and all patients had received systemic high-dose steroid therapy during the previous year. Eleven of 15 patients who received calcium/vitamin D and 15 of 18 patients who additiona lly received sodium fluoride completed the study. The primary endpoint of t he study was the increase of bone mineral density, measured by dual energy X-ray absorptiometry (DXA) after one year of treatment. Bone-specific alkal ine phosphatase and osteocalcin were used as markers for bone turnover. Results In the calcium/vitamin D only group, bone density was not significa ntly changed after one year of treatment, whereas in the calcium/vitamin D/ fluoride group, bone density of the lumbar spine increased from -1.39 +/- 0 .3 (Z-score, mean +/- SEM) to -0.65 +/- 0.3 (P < 0.05) after one year of tr eatment Increase of bone density was positively correlated to the osteoblas tic markers bone-specific alkaline phosphatase (r = 0.53) and osteocalcin ( r = 0.43). Conclusions Sodium fluoride in combination with vitamin D and calcium is an effective, well-tolerated and inexpensive treatment to increase lumbar bon e density in patients with chronic active Crohn's disease and osteoporosis. (C) 2000 Lippincott Williams & Wilkins.