Background: As inflammatory bowel disease (IBD) patients are at risk for low bone mineral density (BMD), we sought to evaluate: 1) the utility of biomechanical CT analysis (BCTA) in assessing bone strength and BMD in IBD patients, 2) Cornerstone guideline utility and 3) clinical features predicting fracture risk. Methods: Consecutive IBD patients who underwent CT enterography (CTE) and BCTA from March 1, 2014 - March 1, 2017 were studied. Records were reviewed to obtain demographic, IBD severity, and treatment data. Measured outcomes were hip and femoral neck World Health Organization classification [normal, osteopenia (-2.5 < T < -1.0), or osteoporosis (T ≤ -2.5)] and fracture risk (not increased, increased or high). Results: 257 patients (53% female; mean age 47 ± 14 years) underwent CTE and BCTA (Crohn disease: 77.0%; 198/257; ulcerative colitis: 21.4%; 55/257; indeterminate colitis: 1.6%; 4/257; Table 1). Hip BMD was normal in 75.7% (184/243), osteopenia in 22.2% (54/243) and osteoporosis in 2.1% (5/243). Femoral neck BMD was normal in 56.8% (142/250), osteopenia in 37.6% (94/250) and osteoporosis in 5.6% (14/250). Fracture risk was increased in 44.7% (114/255) and high in 9.8% (25/255). On multivariate analysis, only increasing age predicted increased fracture risk (OR 1.06 (95% CI: 1.04,1.08), p<0. 001). Cornerstone guidelines were met by 35.3% (41/116), 56.1% (64/114) and 76.0% (19/25) in the not increased, increased, and high fracture risk groups, respectively (p=0.0001) (Table 2). Importantly, 40.3% (56/139) of patients with increased/high fracture risk did not meet screening guidelines. Conclusion: Using BCTA, increased/high fracture risk was detected in over half of this cohort. Increasing age predicted increased fracture risk. A significant proportion of patients with increased/high fracture risk did not meet Cornerstone guidelines. Therefore, patients with IBD who do not meet Cornerstone guidelines may benefit from BCTA screening.
