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Risk factors for low bone mineral density in children and young adults with Crohn's disease
E J Semeao1, A F Jawad, N O Stouffer
1Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
Insights
Low bone mineral density in pediatric Crohn's disease is linked to hypoalbuminemia, corticosteroid use, and specific nutritional therapies. Identifying these risk factors is crucial for bone health management in young patients.
Area of Science:
- Pediatric Gastroenterology
- Bone Metabolism
- Inflammatory Bowel Disease Research
Background:
- Low bone mineral density (BMD) is a significant complication in pediatric Crohn's disease (CD).
- Understanding risk factors is essential for early intervention and management of bone health in affected children and adolescents.
Purpose of the Study:
- To identify key risk factors associated with low BMD in pediatric patients diagnosed with Crohn's disease.
- To inform clinical practice regarding bone health monitoring and preventative strategies.
Main Methods:
- A cohort of 119 pediatric CD patients (ages 5-25) was studied.
- Lumbar spine BMD was measured using dual-energy x-ray absorptiometry.
- Disease activity, nutritional status, medication use, and growth parameters were assessed via chart review and examination.
Main Results:
- Hypoalbuminemia, nasogastric tube feeding, total parenteral nutrition, 6-mercaptopurine, and corticosteroid use were identified as powerful risk factors for low BMD z-scores.
- Specific corticosteroid exposure thresholds (e.g., >7.5 mg/d, cumulative dose, duration) significantly predicted low BMD.
- Disease severity markers like the pediatric Crohn's disease activity index and hospitalization history showed weaker, yet significant, associations with reduced BMD.
Conclusions:
- Several readily assessed clinical factors effectively predict poor bone mineral status in pediatric CD patients.
- Hypoalbuminemia, corticosteroid exposure, and specific nutritional support methods are primary risk factors for low BMD in this population.
- These findings highlight the importance of monitoring bone health and managing associated risk factors in children and adolescents with Crohn's disease.
Objective:
Low bone mineral density (BMD) is a recognized complication of Crohn's disease (CD). The aim of this study was to identify the risk factors for low BMD in pediatric patients with CD.
Study Design:
One hundred nineteen subjects with CD ranging in age from 5 to 25 years were enrolled. BMD of the lumbar spine was measured by dual-energy x-ray absorptiometry. Growth parameters were assessed by examination. Disease-specific variables and use of selected medications were determined by chart review.
Results:
Powerful risk factors for low BMD z-score included hypoalbuminemia, exposure to nasogastric tube feeds, total parenteral nutrition, 6-mercaptopurine, and corticosteroids. Corticosteroid dosing at a level >7.5 mg/d, 5000 mg lifetime cumulative dose, or >12 months of lifetime exposure were significant risk factors for low BMD z-score. Weaker but significant associations with low BMD z-scores included measures of disease severity such as pediatric Crohn's disease activity index, hospital admissions, and length of hospital stay. Site and duration of disease were not predictive.
Conclusions:
The presence of several clinically available factors was predictive of poor bone mineral status in this sample of subjects with CD. Hypoalbuminemia, corticosteroid exposure, nasogastric tube feeds, total parenteral nutrition, and 6-mercaptopurine were the most powerful risk factors for low bone mineral status.
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