P0588Greater consideration needed for bone health in IBD patients receiving corticosteroids: a retrospective single centre experience

Background Recurrent steroid therapy in patients with Inflammatory Bowel Disease (IBD) is associated with a reduction in bone mineral density (BMD) and with osteoporotic risk. The updated 2025 British Society of Gastroenterology (BSG) IBD guidelines highlight the need for IBD-specific data on assessment and management of bone health (1). We aim to report our experience of objective assessment and management of bone health in IBD patients receiving corticosteroids. Methods We collected retrospective data using electronic patient records for all adult patients prescribed prednisolone for IBD between May 2024 and May 2025 at West Middlesex University Hospital, London, UK. Data included patient demographics, disease classification, and BMD measurement if a previous DEXA scan was available. We recorded frequency of lifestyle advice, DEXA requests and recommendations for pharmacotherapy. A retrospective fracture risk assessment (FRAX) score (2) was calculated for each patient to determine the best practice strategy as per National Osteoporosis Guideline Group (NOGG) (3). A daily dose of prednisolone ≥5mg for 3 months is a risk factor in FRAX. In light of evidence indicating exposure of ≥ 1g prednisolone in 3 months (4) (standard IBD cumulative dose is 1.26g for an 8 week course) (1) is associated with an increased fracture risk, a further FRAX score was calculated using this as a threshold for corticosteroid risk. Results We included 131 IBD patients with a median age of 46 (IQR 31–58.5). 88 (67%) had Ulcerative Colitis; 41 (31%) had Crohn’s disease; 2 (2%) had IBD-U. 74 patients (56%) were male. 102 (78%) received one course of prednisolone whilst 29 (22%) had ≥2 courses. Vitamin D was tested in 115 (88%) patients: 13% had deficiency and 21% had insufficiency. According to NOGG thresholds, 102 (78%) were categorised as low risk warranting lifestyle advice; none received this. 29 (22%) were intermediate risk and would warrant BMD assessment; only 4 (14%) received this. When a further FRAX score was calculated accounting for patients receiving a cumulative dose ≥1g prednisolone (4), 103 (79%) of our patients would be eligible for a DEXA scan and two patients would benefit from empirical treatment but none received this. Conclusion Despite limitations of incomplete documentation for additional risk factors including smoking, alcohol and fracture history in this retrospective IBD cohort, these results highlight inadequate risk stratification and documentation of lifestyle modification advice in our patients. We recommend the development of an IBD specific risk factor tool as the existing FRAX calculator may underestimate the impact of age and steroid exposure in IBD populations. References: 1. Moran G, Gordon M, Sinopoulou V, Radford S, Darie AM et al. British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025. Guts [online]. 2025;74:s1-s101. [Accessed 27 October 2025]. Available from: doi.org/10.1136/gutjnl-2024-334395corr1 2. University of Sheffield. FRAX UK fracture risk assessment tool. [Internet]. University of Sheffield: Sheffield; 2025 [Accessed 30 September 2025]. Available from: Frax Calculator | FRAXplus® 3. National Osteoporosis Guideline Group (NOGG). Clinical guideline for the prevention and treatment of osteoporosis. [Internet]. NOGG: UK; 2024 [Accessed 30 September 2025]. Available from: Full Guideline | NOGG 4. Amiche M, Abtahi S, Driessen J, Vestergaard P, de Vries F et al. Impact of cumulative exposure to high-dose oral glucocorticoids on fracture risk in Denmark: a population-based case-control study. Arch Osteoporos. [online]. 2018;13(1):30. [Accessed 26 October 2025]. Available from: 10.1007/s11657-018-0424-x Conflict of interest: Ms. Mulligan, Ciara: No conflict of interest Thaw, Min Thant: No conflict of interest Johnson, Robert: No conflict of interest Johnston, Emma: No conflict of interest Bouri, Sonia: No conflict of interest Mohamed, Zameer: No conflict of interest