engleski

Hypovitaminosis D is prevalent in Crohn´s disease and highly correlate with inflammatory process.

Aim The high incidence of bone disease and increasing evidence for Crohn´s disease (CD) affecting bone status in corticosteroid users and non-users suggest that bone metabolism is affected by inflammatory process per se. The immunomodulatory effects of vitamin D by down- regulating Th1-driven immune response, suggest plausible role in autoimmune disease such as IBD. In patients with CD, we investigated an association of 25- hydroxyvitamin D3 with TNF- family pathway, known as RANK-RANKL-OPG pathway, driven in osteoclastogenesis. Methods Precursor metabolite, 25-hydroxyvitamin D3 was measured in 120 subjects with either long-standing (n=80) and naïve (n=15) Crohn disease, and ulcerative colitis (n=25). The spine and hip bone mineral density (BMD) was measured by DXA. All patients sera were analyzed for free sRANKL, OPG, TNF-α, IL-1β, IL-6, osteocalcin and C-telopeptide. Body mass index was calculated. Results CD patients with low BMD (n=68) have 25(OH)-D3 median, 31 nmol/l (quartile 20-44) in the range of serious deficient to insufficiency, whereas in patients with normal bone status (n=27) it was higher, 39 nmol/l (31- 72), but still in the range of inadequate supply (ANOVA p=0.004). In addition, 75% of naïve CD patients, at diagnosis, showed serious deficiency of 25(OH)-D3: 29 nmol/l (23- 33). In the univariate analysis age, disease duration, body mass index, lumbal and hip BMD, osteocalcin and C- telopeptide were not associated 25(OH)-D3 level. After performing multivariate analysis, proinflammatory cytokines and regulatory molecules of osteoclastogenesis have shown significant correlation. Multiple stepwise regression analysis revealed that free sRANKL (β=- 0.29, inversely) and IL-6 (β=-0.3 inversely) were independent predictors of 25(OH)-D3 level (p=0.018). Conclusion Low serum level of vitamin D is an indicator of bone disease in Crohn´s disease. Presented findings show that 25-hydroxyvitamin D3 level was significantly decreased in either long- standing and naïve patients, and its level is independently but inversely, associated with markers of underlying inflammatory process.

Hypovitaminosis D; Crohn´s disease

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