BACKGROUND: We analyzed the characteristics associated with increased risk of 
osteoporosis in patients with Crohn's disease in Malta.
METHOD: Eighty-three patients with histologically and endoscopically confirmed 
Crohn's disease underwent a DEXA bone density scan and their phenotypic 
characteristics were analyzed.
RESULTS: There was a significant association between body mass index and bone 
mineral density (P = 0.004) and a significant difference in the T scores of 
patients according to age at diagnosis (Montreal Classification: P = 0.0006) 
with patients diagnosed <17 years (n = 13) having lower T scores than those 
diagnosed at older age groups (n = 70). There was a significant difference 
between the T scores of patients on infliximab (n = 33) and those not on 
biological therapy (n = 50, P = 0.0058). Patients with high cumulative 
corticosteroid doses (>10 mg/d for >3 mo, n = 18) had lower bone mineral 
densities than patients who received smaller corticosteroid doses (P = 0.013). 
There was however no significant difference in the T scores of patients 
according to disease location (P = 0.18), disease type (P = 0.64), gender (P = 
0.30), and history of ileal resection (P = 0.68). There was also no significant 
correlation between disease duration and T scores (hip) (P = 0.61).
CONCLUSIONS: Low body mass index, early disease onset, high corticosteroid doses 
and, anti-tumor necrosis factor α therapy are associated with increased risk of 
osteoporosis. Lower T scores in patients on infliximab occur as patients 
receiving this therapy have more severe inflammation, which is associated with 
elevated osteoclastogenic factors, rather than as a side-effect of the 
anti-tumor necrosis factor-α therapy.