Guidelines for osteoporosis in inflammatory bowel disease and coeliac disease

British Society of Gastroenterology

General measures

  • General advice for all patients:
    • encourage frequent weight bearing exercise (including walking, using stairs, gardening and housework)
    • ensure nutritious diet
    • ensure adequate dietary calcium; add calcium tablets if necessary to ensure daily intake of 1000 mg (1200 mg for postmenopausal women and men>55)
    • seek (check calcium, ALP and then consider PTH) and treat vitamin D deficiency
    • no smoking
    • avoid alcohol excess
  • Advise coeliac disease (CD) patients to adhere to strict gluten-free diet
  • Treat inflammatory bowel disease (IBD) energetically to achieve/maintain remission

Steroid avoidance in IBD

  • Steroid avoidance:
  • early use of azathioprine/mercaptopurine
  • use steroids sparingly; consider budesonide instead of prednisolone for small bowel and caecal Crohn’s
  • consider elemental or polymeric diet before steroids in Crohn’s disease
  • consider biologic therapy or surgery if steroid-free remission not achieved

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