Racial Disparities in Prevalence, Screening and Complications of Osteoporosis in Patients with Inflammatory Bowel Disease; A Retrospective Cohort Study

Background Osteoporosis is a complication of inflammatory bowel disease (IBD) with an estimated prevalence of 18-42%. Given the paucity of data, this exploratory study aims to identify racial differences in prevalence, screening, and complications of osteoporosis in patients with IBD. Methods A retrospective cohort study was conducted for patients with IBD and treated at Tufts Medical Center from January 1st 2010 to December 31st 2023. The rates of osteoporosis, osteopenia, and osteoporotic fractures were calculated and compared between White, Black and Asian patients. Dual energy x-ray absorptiometry (DXA) screening rates were compared between the three races. Fisher’s exact test was used to compare categorical variables, and Welch’s t-test was used to compare quantitative data. Multivariable regression analysis was performed to assess the relationship between risk factors and the presence of osteoporosis, osteoporotic fractures, and cumulative events. Glucocorticoid exposure was defined as having had one or more glucocorticoid prescriptions during the study period. Results A total of 2517 patients with IBD were identified. There were 175 (7.0%) Asian, 156 (6.2%) Black, and 2186 (86.8%) White patients. There were statistically higher rates of osteoporosis and osteoporotic fractures in Asian patients compared to Black and White patients respectively; (17.1% vs. 10.9% vs. 9.8%, p = 0.013) and (10.9% vs. 5.1% vs. 6.0%, p = 0.049). Black patients had higher rates of glucocorticoid exposure compared to Asians and Whites (39.1% vs. 28.6% vs. 27.2%, p = 0.007).There were no statistically significant differences in DXA screening rates between races. Conclusions Asian populations with IBD were found to have higher prevalence of osteoporosis and osteoporotic fractures; these differences may reflect unmeasured genetic, environmental, or socioeconomic factors.