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Bone mineral density in children and young adults with Crohn's disease
E J Semeao1, A F Jawad, B S Zemel
1Department of Pediatrics, Children's Hospital of Philadelphia, PA 19104-4399, USA.
Insights
Children and young adults with Crohn's disease (CD) often have reduced bone mineral density (BMD). Routine DXA scans are recommended, especially considering growth and pubertal status.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Bone Metabolism
Background:
- Reduced bone mineral density (BMD) is documented in adults with Crohn's disease (CD).
- Limited data exists on abnormal BMD in pediatric and young adult CD populations.
- Growth and pubertal development's impact on BMD in these patients requires further investigation.
Purpose of the Study:
- To determine the prevalence of low BMD in children and young adults with CD.
- To evaluate the influence of growth and pubertal development on BMD in this cohort.
- To assess the correlation between chronological and bone age-based BMD measurements.
Main Methods:
- Dual-energy X-ray absorptiometry (DXA) was used to measure BMD in 119 CD patients.
- Anthropometry and pubertal development were assessed.
- Bone age was measured in patients over 8 years old with no recent height growth.
Main Results:
- Seventy percent of patients exhibited BMD z-scores ≤ -1.0, with 32% showing z-scores ≤ -2.0.
- Weight and height z-scores significantly correlated with BMD z-scores.
- BMD z-scores differed significantly between males and females.
Conclusions:
- Children and young adults with CD have a high prevalence of low BMD, necessitating routine DXA evaluation.
- Consider bone age-based BMD assessment for patients with a chronological age-based BMD z-score ≤ -2.0.
- Growth and pubertal status are important factors influencing BMD in pediatric CD.
Abstract:
Reduced bone mineral density (BMD) has been reported in adults with Crohn's disease (CD). Less is known about abnormal BMD in children and young adults with CD. The aims of this study are to determine the prevalence of low BMD and to evaluate the effect of growth and pubertal development on BMD in children and young adults with CD. One hundred-nineteen patients with CD underwent dual-energy X-ray absorptiometry (DXA) to determine BMD. Anthropometry and pubertal development were measured. Bone age was measured only in patients older than 8 years of age and who had not grown in height during the last year. One hundred-nineteen patients (72 male, 47 female) were evaluated. Seventy percent of patients had BMD z-scores < or = -1.0 and 32% had z-scores < or = -2.0. Weight and height z-scores were significantly associated with BMD z-scores. BMD z-scores based on bone age and on chronological age were highly correlated, except when the chronological age BMD z-score was < or = -2.0. BMD z-score was significantly different between males and females for the group (-1.75 +/- 1.06 vs. -1.08 +/- 1.00), respectively. Children and young adults with CD have a high prevalence of low BMD and routine evaluation by DXA is indicated. In patients with a chronological age-based BMD z-score < or = -2.0, a bone age-based BMD should be considered.