{
  "abstract": "Introduction Although there is evidence that regional fat affects bone health independently of bone mineral density (BMD), existing fracture risk assessment tools do not sufficiently consider this. The aim is to evaluate if regional fat distribution measured by dual-energy X-ray absorptiometry (DXA) (femoral and abdominal fat percentage) can independently forecast fracture in glucocorticoid-treated IBD populations and if these metrics enhance fracture risk evaluation compared to standard clinical and BMD-based approaches.Methods A large retrospective cross-sectional analysis involving 300 IBD patients receiving glucocorticoids from a total of 1302 patients. Multivariable logistic regression models were fit where the dependent variable was fragility fracture and the independent variables were the regional body composition groups, with the results being adjusted with FRAX clinical factors. The study on glucocorticoid sensitivity focused on those who underwent glucocorticoid treatment and assessed how glucocorticoid exposure affects bone metabolism, comorbidities, and medication use. DXA imaging was used to assess regional adiposity (percentages of abdominal and femoral fat) and BMD at various skeletal sites.Results In the glucocorticoid-treated IBD group, abdominal fat percentage was identified as a new independent predictor of fractures. After accounting for age, gender, BMI, BMD, comorbidities and medications, a 1% rise in abdominal fat percentage was associated with a 5.6% rise in fracture risk (OR=1.06, p=0.018). In contrast, femoral fat percentage did not correlate with fracture risk (p=0.710). Higher BMI was protective (OR=0.92, p=0.039). Calcium and vitamin D treatment was associated with lower odds of fracture (OR=2.4,p=0.012). All other predictors, including age, gender, rheumatoid arthritis, SLE, coeliac disease, type 1 diabetes, hyperparathyroidism, ankylosing spondylitis, vasculitis, malabsorption, low BMI, current excess alcohol, current smoker and both hip and spine BMD, were non-significant (p>0.05) in this model.Conclusions DXA-derived abdominal fat percentage is an independent predictor of fracture risk in the glucocorticoid-treated IBD cohort, unlike femoral fat distribution. The ‘apple phenotype’ of central adiposity should be included in fracture risk calculators and DXA reporting. This suggests a need for IBD-specific fracture risk assessment tools that integrate standard BMD and clinical risk factors within regional body composition.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals of Morecambe Bay, Barrow-in-Furness, United Kingdom"
      ],
      "name": "Suvan Suntharalingam"
    },
    {
      "affiliations": [
        "University Hospitals of Morecambe Bay, Barrow-in-Furness, United Kingdom"
      ],
      "name": "Marwin Bukhari"
    }
  ],
  "title": "P214 Regional fat distribution as a novel predictor of fracture risk in inflammatory bowel disease",
  "uid": "4c9d853d-0e82-5b56-afdf-92b855e7ae96"
}