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Use of quantitative ultrasound to assess osteopenia in children with Crohn disease
Arie Levine1, Leora Mishna, Ami Ballin
1Department of Pediatrics and Pediatric Gastroenterology Units, E. Wolfson Medical Center, the Sackler School of medicine, Tel aviv University, and the Bruce Rappaport School of Medicine, Haifa, Israel. a-levine@inter.net.il
Insights
Quantitative ultrasound (QUS) may not be sensitive enough to detect osteopenia in children with Crohn disease. Dual x-ray absorptiometry (DXA) identified significantly more cases of low bone density in pediatric Crohn disease patients.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Bone Health
Background:
- Children with Crohn disease face a heightened risk of osteopenia and osteoporosis.
- Early osteopenia in these children can lead to increased lifetime fracture risk, necessitating early detection and intervention.
- Dual x-ray absorptiometry (DXA) is the standard for bone mineral density (BMD) assessment but involves radiation and specialized pediatric protocols.
Purpose of the Study:
- To evaluate bone density Z scores using quantitative ultrasound (QUS) with a novel portable device in children with Crohn disease.
- To compare QUS Z scores with DXA measurements for assessing osteopenia in this pediatric population.
Main Methods:
- Speed of sound was measured at the radius and tibia in 35 children with Crohn disease (mean age 14.3 years).
- QUS Z scores were compared to normative values from 1,110 healthy children.
- A subgroup of 26 children with Crohn disease underwent both QUS and DXA for comparative analysis.
Main Results:
- DXA revealed a mean lumbar spine Z score of -1.04 ± 1.51 SD, while QUS showed a mean Z score of -0.15 ± 1.49 SD (p < 0.05).
- Using height-adjusted DXA, 50% of children with Crohn disease had osteopenia, compared to only 19.2% detected by QUS (p < 0.05).
- QUS detected significantly fewer cases of osteopenia, particularly at Z scores up to -2 SD.
Conclusions:
- Quantitative ultrasound performed on the radius and tibia may lack the sensitivity to accurately detect osteopenia in children with Crohn disease.
- DXA remains a more sensitive method for identifying low bone density in pediatric Crohn disease patients.
Background And Aims:
Children with Crohn disease are at increased risk for osteopenia and osteoporosis. Early development of osteopenia can increase the lifetime risk for fractures and may be amenable to early intervention. The gold standard for measuring bone mineral density (BMD) and fracture risk is dual x-ray absorptiometry (DXA), but this involves some radiation and specialized programs for measuring BMD in children. Bone density Z scores were evaluated with quantitative ultrasound (QUS) using a novel portable device and were compared with DXA in children with Crohn disease.
Methods:
Thirty-five children with documented Crohn disease (mean age 14.3 +/- 2.3 years) had speed of sound measured at the left radius and left tibia. Normative values for QUS Z scores were calculated from a cohort of 1,110 healthy children. A subgroup of 26 children with Crohn disease underwent both QUS and DXA. Z scores were calculated and compared for both groups.
Results:
The mean Z score using lumbar spine DXA was -1.04 +/- 1.51 SD, compared with -0.15 +/- 1.49 SD, using the lowest Z score for QUS ( < 0.05). Using height adjusted DXA, 50% of children with Crohn disease had osteopenia, whereas QUS detected only 19.2% of these children ( < 0.05). Significantly fewer cases of osteopenia were detected using QUS at Z scores up to -2 SD.
Conclusions:
Quantitative ultrasound performed on the radius and tibia may not be sensitive enough to pick up osteopenia in children with Crohn disease.
