Counteracting Bone Mineral Loss and Secondary Sarcopenia in Inflammatory Bowel Disease Through Resistance and Weight-Bearing Exercise: A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.72.75063Keywords
inflammatory bowel disease, Crohn's disease, ulcerative colitis, resistance exercise, bone mineral density, osteosarcopeniaAbstract
Background: Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is a chronic immune-mediated disorder of the gastrointestinal tract. It is associated with an increased risk of secondary osteoporosis and low bone mineral density (BMD), mainly due to chronic inflammation, nutrient malabsorption, long-term glucocorticoid therapy, and physical inactivity, which also contributes to sarcopenia.
Aim: To evaluate the evidence on resistance and weight-bearing exercise as non-pharmacological strategies to improve BMD, preserve muscle mass, and reduce secondary osteosarcopenia in patients with IBD.
Material and methods: A literature review was conducted using PubMed and Scopus. Randomized controlled trials and observational studies evaluating structured exercise interventions lasting at least 4 weeks in pediatric and adult IBD patients were included.
Results: Available evidence indicates that structured exercise, particularly combined resistance and weight-bearing training, improves lumbar spine and hip BMD. Studies in pediatric and young adult patients show that 6-12 months of training increases lean body mass and bone mineral content. Mechanical loading during resistance exercise stimulates bone formation and the release of anti-inflammatory myokines, including irisin, which may regulate the RANKL/OPG pathway and reduce inflammatory signaling. Exercise is generally safe, does not increase disease activity, and improves health-related quality of life.
Conclusions: Regular, individualized resistance and weight-bearing exercise should be considered an important adjunctive therapy for preventing bone loss and secondary sarcopenia in IBD. Effective implementation requires collaboration between gastroenterologists and rehabilitation specialists to provide safe, tailored exercise programs.
References
1. Ahn, M. B., & Yoo, I. H. (2023). Risk factors of low bone mineral density in newly diagnosed pediatric inflammatory bowel disease. Nutrients, 15(24), 5048. https://doi.org/10.3390/nu15245048
2. Aibar-Almazán, A., Voltes-Martínez, A., Castellote-Caballero, Y., Afanador-Restrepo, D. F., Carcelén-Fraile, M. C., & López-Ruiz, E. (2022). Current status of the diagnosis and management of osteoporosis. International Journal of Molecular Sciences, 23(16), 9465. https://doi.org/10.3390/ijms23169465
3. Ata, B. N., & Eyigor, S. (2024). What aspects do we overlook in the rehabilitation of patients with inflammatory bowel disease? World Journal of Gastroenterology, 30(27), 3268–3272. https://doi.org/10.3748/wjg.v30.i27.3268
4. Chang, X., Xu, S., & Zhang, H. (2022). Regulation of bone health through physical exercise: Mechanisms and types. Frontiers in Endocrinology, 13, 1029475. https://doi.org/10.3389/fendo.2022.1029475
5. Choi, A., Jung, S. H., Kim, S., & Lee, J. S. (2023). Risk factors for the occurrence and severity of vertebral fractures in inflammatory bowel disease patients: A nationwide population-based cohort study. Journal of Korean Medical Science, 38(28), e210. https://doi.org/10.3346/jkms.2023.38.e210
6. Dai, Z., Xu, W., Ding, R., Peng, X., Shen, X., Song, J., Du, P., Wang, Z., & Liu, Y. (2023). Two-sample Mendelian randomization analysis evaluates causal associations between inflammatory bowel disease and osteoporosis. Frontiers in Public Health, 11, 1151837. https://doi.org/10.3389/fpubh.2023.1151837
7. Derbey, L., Charlois, A. L., Buisson, A., Roblin, X., Mathieu, N., Danion, P., Gay, C., Nancey, S., & Boschetti, G. (2024). Physical activity and IBD: State of art and knowledge, patients and healthcare professionals points of view, a French multicenter cross sectional study. Inflammatory Bowel Diseases, 30(12), 2306–2313. https://doi.org/10.1093/ibd/izae009
8. González-Aroca, J., Olivares-Arancibia, J., Quera, R., Sepúlveda-Loyola, W., Barros-Osorio, C., Mello, J. B., López-Gil, J. F., & Plaza-Diaz, J. (2026). Exercise for bone mineral density in people with inflammatory bowel disease: A systematic review. Healthcare, 14(11), 1448. https://doi.org/10.3390/healthcare14111448
9. Hofbauer, L. C., Rauner, M., Compston, J. E., & Tsourdi, E. (2025). Glucocorticoid-induced osteoporosis: A novel concept. Lancet Diabetes & Endocrinology, 13(12), 964–979. https://doi.org/10.1016/S2213-8587(25)00251-7
10. Hoogendijk, E. O., & Dent, E. (2023). Lifestyle interventions for frailty and osteoporosis: A consensus-based summary of clinical practice guidelines. Current Osteoporosis Reports, 21(2), 211–222. https://doi.org/10.1007/s11914-023-00777-y
11. Jones, K., Kimble, R., Baker, K., & Tew, G. A. (2022). Effects of structured exercise programmes on physiological and psychological outcomes in adults with inflammatory bowel disease (IBD): A systematic review and meta-analysis. PLoS ONE, 17(12), e0278480. https://doi.org/10.1371/journal.pone.0278480
12. Kasznar, E., Csendes, B., Gergő, D., Hegyi, P., Tóth, R., Fogarasi, A., Garami, M., Ocskay, K., Párniczky, A., Obeidat, M., & Müller, K. E. (2026). Physical activity improves quality of life in patients with inflammatory bowel disease: A systematic review and meta-analysis. Journal of Cachexia, Sarcopenia and Muscle, 17(1), e70206. https://doi.org/10.1002/jcsm.13428
13. Kreienbuehl, A. S., Rogler, G., Burri, E., Biedermann, L., Meier, C., Juillerat, P., Restellini, S., Hruz, P., Vavricka, S. R., Aeberli, D., & Seibold, F. (2024). Bone health in patients with inflammatory bowel disease. Swiss Medical Weekly, 154, 3407. https://doi.org/10.57187/smw.2024.3407
14. Lee, J. M., Han, K., Lee, K. M., & Yun, J. S. (2023). Fracture risk in middle-aged and older patients with inflammatory bowel disease: A Korean nationwide population-based cohort study. Journal of Korean Medical Science, 38(35), e275. https://doi.org/10.3346/jkms.2023.38.e275
15. Lewandowski, K., Kaniewska, M., Więcek, M., Szwarc, P., Panufnik, P., Tulewicz-Marti, E., Walicka, M., Franek, E., & Rydzewska, G. (2023). Risk factors for osteoporosis among patients with inflammatory bowel disease – Do we already know everything? Nutrients, 15(5), 1151. https://doi.org/10.3390/nu15051151
16. Li, C. C., Xu, L. P., Zheng, T. T., & Wu, X. L. (2026). The effects of steroid treatment on osteoporosis in patients with inflammatory bowel disease: A systematic review and meta-analysis. Medicine, 105(3), e47173. https://doi.org/10.1097/MD.0000000000047173
17. Macready, M., Loher, M., Finney-Hayward, T., & Raine, T. (2025). Adverse events associated with IBD-related corticosteroid (CS) use were frequent and differed substantially between pharmacovigilance databases and a patient questionnaire. Journal of Crohn's and Colitis, 19(2), jjae138. https://doi.org/10.1093/ecco-jcc/jjae138
18. Ratajczak, A. E., Szymczak-Tomczak, A., Michalak, M., Rychter, A. M., Zawada, A., Dobrowolska, A., & Krela-Kaźmierczak, I. (2022). Associations between vitamin D, bone mineral density, and the course of inflammatory bowel disease in Polish patients. Polish Archives of Internal Medicine, 132(12), 16329. https://doi.org/10.20452/pamw.16329
19. Ratajczak-Pawłowska, A. E., Hryhorowicz, S., Szymczak-Tomczak, A., Wysocka, E., Michalak, M., Kaczmarek-Ryś, M., Lis-Tanaś, E., Bielawska, L., Pławski, A., Słomski, R., Dobrowolska, A., & Krela-Kaźmierczak, I. (2024). Genetic variants of MTHFR gene in relation to folic acid levels and bone mineral density in Polish patients with inflammatory bowel disease. Journal of Applied Genetics, 65(1), 73–81. https://doi.org/10.1007/s13353-023-00792-6
20. Reddy, A., Burstiner, L. S., Patel, N., Qadir, N., Diaz-Garcia, G., Sulbaran, M., & Stemboroski, L. (2026). Corticosteroid use, bone density screening, and the influence of insurance in patients with inflammatory bowel disease: A retrospective analysis. BMC Gastroenterology, 26(1), 249. https://doi.org/10.1186/s12876-026-04717-5
21. Sigurdsson, G. V., Schmidt, S., Mellstrom, D., Ohlsson, C., Karlsson, M., Lorentzon, M., & Saalman, R. (2021). Physical exercise is associated with beneficial bone mineral density and body composition in young adults with childhood-onset inflammatory bowel disease. Scandinavian Journal of Gastroenterology, 56(6), 699–707. https://doi.org/10.1080/00365521.2021.1904238
22. Sigurdsson, G. V., Saalman, R., Schmidt, S., Mellstrom, D., Ohlsson, C., & Lorentzon, M. (2023). SMI and physical exercise are associated with volumetric bone mineral density and bone microarchitecture in young adults with childhood-onset IBD. Inflammatory Bowel Diseases, 29(6), 931–941. https://doi.org/10.1093/ibd/izac181
23. Sinclair, J., Brooks-Warburton, J., & Bottoms, L. (2024). Perceptions, behaviours and barriers towards exercise practices in inflammatory bowel disease. PLoS ONE, 19(4), e0299228. https://doi.org/10.1371/journal.pone.0299228
24. Skrzypczak, D., Ratajczak, A. E., Szymczak-Tomczak, A., Dobrowolska, A., Eder, P., & Krela-Kaźmierczak, I. (2021). A vicious cycle of osteosarcopenia in inflammatory bowel diseases – Aetiology, clinical implications and therapeutic perspectives. Nutrients, 13(2), 293. https://doi.org/10.3390/nu13020293
25. Sobieszek, K. A., & Idzik, P. (2025). Physical activity and inflammatory bowel diseases: Evidence from animal models. Quality in Sport, 45, 66461. https://doi.org/10.12775/QS.2025.45.66461
26. Steell, L., Gray, S. R., Russell, R. K., MacDonald, J., Seenan, J. P., Wong, S. C., & Gaya, D. R. (2021). Pathogenesis of musculoskeletal deficits in children and adults with inflammatory bowel disease. Nutrients, 13(8), 2899. https://doi.org/10.3390/nu13082899
27. Trivić, I., Sila, S., Mišak, Z., Niseteo, T., Tripalo Batoš, A., Hojsak, I., & Kolaček, S. (2023). Impact of an exercise program in children with inflammatory bowel disease in remission. Pediatric Research, 93(7), 1999–2004. https://doi.org/10.1038/s41390-022-02362-8
28. Wu, S., Ye, Z., Yan, Y., Zhan, X., Ren, L., Zhou, C., Chen, T., Yao, Y., Zhu, J., Wu, S., Ma, F., Liu, L., Fan, B., & Liu, C. (2023). The causal relationship between autoimmune diseases and osteoporosis: A study based on Mendelian randomization. Frontiers in Endocrinology, 14, 1196269. https://doi.org/10.3389/fendo.2023.1196269
29. Xu, D., Chen, Y., Gao, X., Xie, W., Wang, Y., Shen, J., Yang, G., & Xie, B. (2023). The genetically predicted causal relationship of inflammatory bowel disease with bone mineral density and osteoporosis: evidence from two-sample Mendelian randomization. Frontiers in Immunology, 14, 1148107. https://doi.org/10.3389/fimmu.2023.1148107
30. Xu, X., Ma, Q., You, P., & Wu, J. (2026). The brain–bone–gut axis: a microbial bridge underlying multisystem comorbidities. Frontiers in Endocrinology, 17, 1755305. https://doi.org/10.3389/fendo.2026.1755305
31. Yang, Y. J., & Jeon, S. R. (2025). Osteosarcopenia in inflammatory bowel disease: A clinical overview. The Korean Journal of Internal Medicine, 40(2), 307–317. https://doi.org/10.3904/kjim.2024.359
32. Zerlotin, R., Oranger, A., Pignataro, P., Dicarlo, M., Maselli, F., Mori, G., Colucci, S. C., Grano, M., & Colaianni, G. (2022). Irisin and secondary osteoporosis in humans. International Journal of Molecular Sciences, 23(2), 690. https://doi.org/10.3390/ijms23020690
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Anna Hajduk, Piotr Szymański, Klaudia Borycka, Aleksandra Szymańska, Filip Kostanek, Jagoda Stańska, Aleksandra Baranowska, Aleksandra Dobrzańska, Kacper Kmieciak, Maria Berek
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 2
Number of citations: 0
