Calcium intake may be poor because of dairy product or other food avoidance. Calcium may be eaten in foods but poorly absorbed in patients with small-intestinal disease or resection. In the past, standard x-ray was used to detect osteoporosis but this only detects advanced bone disease. Occasionally, bone biopsy was performed. Recently, bone densitometry has provided a sensitive measure of detecting bone mass.
Prednisone decreases bone synthesis and increases bone breakdown.
Long-term prednisone therapy inhibits intestinal calcium absorption and causes bone breakdown. Other secondary effects of prednisone therapy contribute to calcium loss. Discontinuation of prednisone or the reduction of the dose to below 5 mg per day is the most important measure for preventing IBD-related bone loss, if this is clinically possible. Supplementation of calcium and Vitamin D are other modes of therapy for IBD-related bone disease. Patients with IBD should have daily calcium intake of at least 1000 mg in the form of calcium-rich foods or supplements.