1. Serial measurements of total body calcium have been made by prompt γ-neutron activation analysis in 13 patients with inflammatory bowel disease over a mean period of 23 months. Changes in spinal trabecular bone mineral density and radial shaft bone mineral content were also assessed by using quantitative computed tomography and single photon absorptiometry, respectively.

2. The mean annual decreases (95% confidence intervals) were: total body calcium, 7.8% (−12.0 to −3.7%; P <0.001); spinal trabecular bone mineral density, 2.5% (−5.0 to +0.1%; 0.05 <P <0.1), radial bone mineral content, 2.1% (−3.4 to −0.8%; P <0.01).

3. No significant correlations were found between rates of change of the three variables. However, there were significant positive correlations between the baseline values for total body calcium and radial bone mineral content (r = 0.638, P <0.05), spinal bone mineral density and radial bone mineral content (r = 0.854, P <0.01), and total body calcium and spinal bone mineral density (r = 0.876, P <0.001).

4. These results demonstrate rapid decreases in total body calcium in patients with inflammatory bowel disease which, in conjunction with the significant decrease in radial shaft bone mineral content, indicate increased rates of cortical bone loss. Whilst values for bone mass at different skeletal sites showed positive correlations within individuals, no relationship was found between the rates of change in bone mass at these sites.

5. The rapid bone loss observed in some subjects emphasizes the importance of early detection of osteoporosis by bone densitometry and the need for effective prophylactic measures to be established in this group of patients.

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