Bones and IBD Part 3

How can bone loss be prevented?

Osteoporosis is far better prevented than treated. If you are concerned that you may develop weak bones, the following suggestions may help:

• If you can, take regular weight-bearing exercise, such as brisk walking, jogging, dancing, aerobics, or active team sports. Gardening and housework, even just using the stairs whenever possible, can also be useful, as any weight-bearing activity stimulates bone formation. If in doubt, ask your doctor for guidance on exercise.
• Avoid smoking and reduce alcohol intake.
• Ensure you have adequate calcium and vitamin D, which are important for bone strengthening. (See list of sources at the end). The daily recommended intake of Vitamin D is 800 units. Guidelines for people with IBD recommend a daily intake of 1000mg of calcium for people under 55.
• If you are not getting enough calcium from your food, perhaps because you are avoiding dairy products, you may need calcium supplements. Discuss this with your doctor - you may be able to get combined calcium and vitamin D supplements on prescription. Some people overestimate their dairy sensitivity, and avoid milk and milk products unnecessarily. 
• If you are taking steroids, talk about prevention of bone loss with your doctor or IBD team. Calcium and vitamin D supplements are even more important for those on steroid treatment. You may also be given bisphosphonates while on steroids. Some of the newer steroids, such as budesonide, may be less harmful to the bones, and may be suitable for some forms of Crohn’s Disease. 
• Prolonged use of steroids can sometimes be avoided by the use of 5 drugs such as azathioprine and  infliximab. Some research suggests that infliximab may improve bone density in people with Crohn’s Disease.
• Continuing to take your IBD medications may reduce the risk of osteoporosis by minimising the amount of ongoing inflammation in the gut.

By being aware of the risk of bone loss, you may be able to change your diet or lifestyle to help prevent it. Also, appropriate treatment can now significantly reduce the risk of bone disease. 

Sources of Calcium
Dairy sources

 Milk (skimmed milk contains slightly more calcium than whole milk)
 Hard and soft cheeses
 Yoghurt, fromage frais, dairy ice cream.

Non-dairy sources
 Fortified soya milk
 Tofu 
 Green leafy vegetables such as broccoli and cabbage 
 Fish with edible bones, such as pilchards and sardines
 Nuts.

Sources of Vitamin D
 Exposure to sunlight
 Oily fish such as salmon and sardines
 Eggs
 Fortified fat spreads and breakfast cereals. 

For more information see our information leaflet Bones and IBD.