Bone density loss in Crohn’s disease: role of TNF and potential for prevention by bupropion

The subject of bone mineral density loss in CD has been recently reviewed; tumour necrosis factor α (TNF-α) is suspected of being an important mediator of this loss. 1, 2 Evidence has been published for localised overproduction of TNF-α being largely responsible for the bone loss seen in rheumatoid arthritis, 3, 4 psoriatic arthritis, 5 multiple myeloma, 6 hip prosthesis loosening, 7 periodontal disease, 8 and spondyloarthropathies. 9 Anti-TNF-α antibody has been shown to slow the bone loss of spondyloarthropy 9 and rheumatoid arthritis. 3, 10 We have found that the commonly used antidepressant bupropion can induce remission in CD 11, 12 and have found that bupropion can lower TNF-α levels. 13 If bupropion is found to be effective in CD and to lower TNF-α levels in large trials, it might be considered for use in bone loss and osteoporosis, in CD or otherwise.