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Published on: January 29, 2018
Lumbar spine bone mineral density at diagnosis and during follow-up in children with IBD
Arun Gupta1, Shirley Paski, Robert Issenman
1McMaster Children's Hospital and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Insights
Children with inflammatory bowel disease (IBD) may have reduced lumbar spine bone mineral density (BMD). Crohn's disease patients showed lower BMD, while ulcerative colitis patients were similar to controls. Some children experienced BMD loss over time.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Bone Metabolism
Background:
- Children with inflammatory bowel disease (IBD) are at risk for bone density deficits.
- Accurate assessment of bone mineral density (BMD) in pediatric IBD is crucial for monitoring growth and treatment efficacy.
Purpose of the Study:
- To evaluate lumbar spine BMD in children with IBD compared to healthy controls.
- To identify factors associated with reduced BMD and bone loss in pediatric IBD patients.
Main Methods:
- Lumbar spine BMD was measured using dual-energy X-ray absorptiometry (DXA) in 123 children with IBD (Crohn's disease and ulcerative colitis) and 46 healthy children.
- BMD Z-scores were calculated, and longitudinal changes were assessed over follow-up periods ranging from 1.7 to 8.7 years.
Main Results:
- Densitometer-derived reference values overestimated spine BMD in healthy children, particularly younger ones.
- Children with Crohn's disease exhibited significantly lower lumbar spine BMD (Z-scores: -1.44 males, -1.37 females) compared to controls.
- Children with ulcerative colitis showed BMD Z-scores similar to controls (males: -0.93, females: -0.56).
- No significant average BMD Z-score reduction was observed during follow-up, but six patients (3 CD, 3 UC) showed BMD loss relative to expected growth.
Conclusions:
- Children with Crohn's disease have reduced lumbar spine BMD, necessitating careful monitoring.
- While average BMD is stable, a subset of pediatric IBD patients may experience bone loss, particularly young males not on immunosuppressants.
- Current reference values may overestimate BMD in pediatric populations, highlighting the need for age- and sex-specific pediatric norms.
Abstract:
Lumbar spine body mineral density (BMD) was measured in 123 children (65 male, 58 female) suffering from inflammatory bowel disease (IBD) (82 Crohn's disease, 41 ulcerative colitis) and in 46 children (25 male, 21 female) without any history of bone disease. Results in normal children showed that densitometer-derived reference values overestimated spine BMD, particularly for young children, such that the reported mean Z-scores for normal 10-yr-old children were -0.83 for males and -0.72 for females. For children with Crohn's disease, the lumbar spine BMD was further reduced (Z-score = -1.44 for males, Z-score = -1.37 for females). For children with ulcerative colitis, the lumbar spine BMD was similar to that of normal children (Z-score = -0.93 for males, Z-score = -0.56 for females). There was no statistically significant reduction in average spine BMD Z-scores during follow-up periods ranging from 1.7 to 8.7 yr. When growth patterns were examined in individual children, six patients (three Crohn's disease, three ulcerative colitis) were identified as losing spine BMD with respect to their baseline value and their expected pattern of BMD increase associated with normal growth. The children suffering from IBD who, most likely, will not maintain expected growth-related increases in spine BMD are those who are male, relatively young at diagnosis, and unlikely to be taking immunosuppressants.
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