Prevalence rates and an evaluation of reported risk factors: RESULTS

28 Dec
2011

Osteonecrosis rates: The records of 877 patients with Crohn’s disease seen during a 20-year period were retrospec­tively analyzed to determine the frequency of osteonecrosis and possible factors that might have influenced its develop­ment. This represented the entire clinical experience of a sole gastroenterologist in a tertiary care university teaching hospital. Of these 877 patients, 492 (56.1%) were fe­male and 385 (43.9%) were male. Therefore, the overall os- teonecrosis rate in this series of Crohn’s disease patients was four in 877 (approximately 0.5%). All patients with os- teonecrosis were male, so the actual rate of osteonecrosis in men was four in 385 (about 1%). No women were detected with osteonecrosis.

Characteristics of Crohn’s disease: Table 1 shows the clini­cal characteristics of the four male patients with osteonecrosis detected in this group of 877 patients with Crohn’s disease. All patients had a diagnosis of Crohn’s disease estab­lished before age 40 years. All patients had at least colonic involvement, and three also had ileal inflammatory changes. The clinical behaviour of the Crohn’s disease was classified as penetrating in two, but no patient had stricturing or stenosing disease. Of these four patients, three had a central spondyloarthropathy, a peripheral arthropathy or both. Other extraintestinal features associated with Crohn’s dis­ease were not observed. One patient died with a metastatic colorectal cancer. Follow-up data were available on all 877 patients with a mean of 7.8 years.

TABLE 1 Characteristics of Crohn’s disease in osteonecrosis patients treated at the University of British Columbia Hospital, Vancouver, British Columbia

Behaviour+

Extraintestinal

Age*/sex

Site

features

Other

28/male

Ileocolon

Nonstricturing and nonpenetrating

Peripheral arthropathy

29/male

Colon

Penetrating

None

Colorectal cancer

36/male

Ileocolon

Penetrating

Spondylo- arthropathy and peripheral arthropathy

19/male

Ileocolon

Nonstricturing and nonpenetrating

Spondylo- arthropathy

Characteristics of osteonecrosis: Table 2 shows character­istics of the osteonecrosis. Three of the four patients devel­oped osteonecrosis after the diagnosis of Crohn’s disease was established; two of these three patients received corticoster- oids and parenteral nutrition, while one patient did not re­ceive either form of therapy. In one patient, the diagnosis of osteonecrosis was established concomitant with the diagno­sis of Crohn’s disease; this patient did not receive cortico- steroids or parenteral nutrition. All patients had bilateral osteonecrosis detected in the femoral heads. Two patients also had changes of osteonecrosis detected in the other sites, in particular, the humerus; both patients received corticosteroids and parenteral nutrition. One patient also had a re­cent history of a work-related traumatic injury to his shoulder. None of the four patients was an alcohol abuser or provided evidence of alcohol use, even indirect, such as al­tered liver chemistry tests. Two patients received orthopedic surgical treatment for their osteonecrosis. One patient had hip replacement surgery, and one patient had decompressive drilling. Two patients refused surgical treatment. Follow-up periods for the two osteonecrosis patients treated with ster­oids were 22 months and 59 months, respectively, for a mean of 3.3 years, while follow-up periods for the two patients not treated with steroids were 24 months and 80 months, respec­tively, for a mean of 4.3 years.
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TABLE 2 Characteristics of osteonecrosis patients with Crohn’s disease treated at the University of British Columbia Hospital, Vancouver, British Columbia

Age*/sex

Age Dx

Bones involved

Steroids

TPN

SB resection

28/male

29

1H, 2FC, 2FH

Yes

Yes

No

29/male

33

2H, 2FH

Yes

Yes

No

36/male

36

2FH

No

No

No

19/male

23

2FH

No

No

No

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