Researchers have found that patients with inflammatory bowel disease (IBD) have a significantly increased risk of fractures. Epidemiological studies have shown that people with IBD are more likely to suffer from osteoporosis compared to non-IBD populations. Osteoporosis and its serious consequence, fracture, are known as a silent epidemic in our country for constituting a serious public health problem. 1. Risk factors for osteoporosis caused by IBD The pathogenesis of reduced BMD in people with IBD is not fully understood. The application of hormone therapy, small bowel disorders, small bowel resection, persistent or extensive lesions of the disease,,, vitamin D deficiency, malabsorption, malnutrition, hypogonadism and systemic inflammation are high risk factors for bone loss, but many studies have found that in patients newly diagnosed with IBD The incidence of reduced BMD is high, and these results suggest the presence of other factors prior to the onset of IBD that lead to low bone mass and increased bone loss. 2. Prevention and treatment of osteoporosis Prevention and treatment of osteoporosis include lifestyle interventions, regular weight training, reduction of alcohol intake, smoking cessation, maintenance of adequate dietary calcium nutritional intake, adequate calories to achieve ideal body weight, vitamin D supplementation, and restriction of sodium intake (2-3 g/d). It is also important to control disease progression: reduce systemic inflammation and alleviate cachexia. hormone replacement therapy in postmenopausal women with IBD may reduce bone loss. Patients requiring long-term glucocorticoid therapy should be properly evaluated and proactive measures should be taken to prevent and treat osteoporosis caused by glucocorticoids. Because the magnitude of bone loss is related to the dose of glucocorticoids, the lowest effective dose possible and the use of topical preparations should be used. There are three classes of drugs used to prevent and treat osteoporosis: (1) Anti-bone resorption agents, such as estrogens, calcitonin, and diphosphonates. Diphosphonates are the first-line drugs for the prevention of IBD-related osteoporotic fractures. Studies with alendronate and risedronate have shown a reduction in fracture risk by reducing bone turnover and increasing BMD. (2) Drugs that promote bone formation, such as fluoride and anabolic steroids. Fluoride stimulates the replication, differentiation and function of osteoblasts in patients on glucocorticoids and restores the glucocorticoid-induced decrease in serum osteocalcin levels. This suggests that fluoride may increase bone formation. (3) Drugs that promote mineralization, such as calcium preparations, vitamin D, etc. As an essential nutrient and hormone, vitamin D plays an important role in maintaining the balance of calcium and phosphorus metabolism in the body. Calcium preparations are one of the drugs with more certain efficacy and safety in the treatment of osteoporosis. Medication can reduce the pain of osteoporosis, increase bone mass, and prevent fractures. In a prospective double-blind randomized parallel controlled study of 94 patients with IBD, calcium and vitamin D supplementation for one year was shown to increase lumbar spine BMD. In addition, parathyroid hormone (PTH) enhances osteoclast lysis of bone calcium and osteoclast resorption of bone matrix, while promoting osteoblast formation and mineralized bone. In this way, bone calcium is continuously released to maintain blood calcium levels and old bone is continuously replaced by new bone. A recent study by Dempster et al. demonstrated that PTH increased the thickness and joint density of the human bone cortex, and a three-year study by Cosman et al. reported that PTH was effective against vertebral fractures. It increases bone strength and reduces the risk of fracture. Vitamin K acts mainly by increasing the synthesis and secretion of osteocalcin (BGP), which is a bone formation promoter. Others, such as growth hormone, anabolic hormone, bioestrogens, and selective estrogen receptor modulators, some of which have not been widely used clinically and need to be further evaluated. Because of the risk factors for osteoporosis and reduced BMD in patients with IBD, BMD should be routinely measured and spinal X-rays should be performed to enable early initiation of treatment and reduce the incidence of fractures.