Therapeutic Advances in Gastroenterology · 10 authors, 17 centres
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This systematic review and meta-analysis found that microscopic colitis (MC) is associated with a twofold increased risk of low bone density (LBD). Among MC patients, 68% had LBD, 51% had osteopenia, and 11% had osteoporosis. The authors recommend screening for bone mineral density at the time of MC diagnosis.
**Background:** Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by watery diarrhea, which may lead to calcium and vitamin D loss and subsequent low bone density (LBD). The relationship between MC and bone mineral density has not been comprehensively evaluated. This systematic review and meta-analysis aimed to assess whether MC is a risk factor for LBD and to determine the proportion of MC patients with LBD.
**Methods:** A systematic search of five databases (PubMed, Embase, Cochrane, Scopus, Web of Science) was conducted from inception to October 16, 2021. Studies reporting bone density measurements in adult MC patients were included. Four observational studies (three full-text articles and one conference abstract) were eligible for quantitative synthesis: Graziano 2021 (retrospective case-control, USA, 47 MC patients), Greenberg 2019 (retrospective case-control, USA, 94 MC patients), Wildt 2018 (prospective cohort, Denmark, 50 MC patients), and Lőrinczy 2011 (cross-sectional, Hungary, 14 MC patients). All studies used age- and sex-matched controls. A random-effects model was used to calculate pooled odds ratios (ORs) and pooled event rates with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Quality of evidence was evaluated using GRADE.
**Key Results:** The odds of having LBD were twofold increased in the presence of MC (OR = 2.13, CI: 1.42–3.20, I² = 37%). The odds of osteopenia were 2.45 (CI: 1.11–5.41, I² = 35%), and the odds of osteoporosis were 1.42 (CI: 0.65–3.12, I² = 0%). Among MC patients, the proportion of LBD was 0.68 (CI: 0.56–0.78), osteopenia was 0.51 (CI: 0.43–0.58), and osteoporosis was 0.11 (CI: 0.07–0.16). When excluding the conference abstract, the odds of LBD increased to threefold (OR = 2.96, CI: 1.15–7.59). The certainty of evidence was rated as very low due to the small number of studies, wide confidence intervals, and use of surrogate outcomes.
**Clinical Implications:** This is the first meta-analysis demonstrating a significant association between MC and LBD. Given that two-thirds of MC patients have LBD, the authors recommend screening for bone mineral density at the time of MC diagnosis. Lifestyle modifications, dietary changes, and calcium/vitamin D supplementation may help slow LBD progression. Further prospective studies with longer follow-up are needed to clarify fracture risk and the role of budesonide therapy.