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Altered bone mass in children at diagnosis of Crohn disease: a pilot study
Manisha Harpavat1, Susan L Greenspan, Carey O'Brien
1Department of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh School of MedicinePittsburgh, PA 15213, USA. manisha.harpavat@chp.edu
Insights
Newly diagnosed pediatric Crohn disease patients often have reduced bone mass, even without corticosteroid use. This suggests Crohn disease itself impacts bone health in children.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Bone Metabolism
Background:
- Reduced bone mineral density (BMD) is a known complication in children with inflammatory bowel disease (IBD).
- Corticosteroid therapy is frequently implicated as the primary cause of decreased BMD in these patients.
- The independent effect of Crohn disease on bone health in steroid-naive children remains less understood.
Purpose of the Study:
- To investigate the prevalence of reduced bone mass in children newly diagnosed with Crohn disease (CD) prior to corticosteroid treatment.
- To assess the relationship between disease activity, nutritional status, pubertal development, and bone mass in these patients.
- To determine if Crohn disease itself contributes to impaired bone mineral density independent of corticosteroid use.
Main Methods:
- Dual-energy X-ray absorptiometry (DXA) was performed on 18 steroid-naive children with newly diagnosed CD.
- Measurements included total body and lumbar spine bone mineral density (BMD) z-scores, adjusted for bone age.
- Disease activity, growth, pubertal status, and nutritional intake (calcium, vitamin D, calories) were assessed.
Main Results:
- 28% of patients exhibited reduced total BMD (z-score < -1), with 6% showing a z-score < -2.
- 56% of patients had reduced lumbar spine BMD (z-score < -1), with 11% showing a z-score < -2.
- Significantly lower mean lumbar spine BMD z-scores were observed (P = 0.002). Delayed puberty correlated with whole-body BMD z-scores (r = 0.64; P = 0.004). Nutritional deficiencies and lack of physical activity were prevalent.
Conclusions:
- Decreased bone mass is a common finding in children newly diagnosed with Crohn disease, even before corticosteroid exposure.
- These findings indicate that Crohn disease itself contributes to impaired bone mass accrual in pediatric patients.
- Early assessment and management of bone health are crucial in newly diagnosed pediatric Crohn disease patients, irrespective of corticosteroid treatment.
Objectives:
Recent studies have indicated that bone mineral density is reduced in children with inflammatory bowel disease. The exact cause of this reduction is unclear, but it is often attributed to corticosteroid use. This study examined the prevalence of reduced bone mass in otherwise healthy children newly diagnosed with Crohn disease without previous corticosteroid exposure.
Methods:
Eighteen steroid-naive children newly diagnosed with Crohn disease underwent dual energy x-ray absorptiometry. Disease activity, growth and pubertal development, nutritional assessment and bone mass measurements were recorded. z scores were adjusted for bone age.
Results:
Five of the 18 patients (28%) had a total bone mineral density z score less than -1 (one had a z score less than -2). Ten (56%) subjects had lumbar spine bone mineral density z scores less than -1 (two had z score less than -2). The subjects had significantly reduced mean lumbar spine bone mineral density z scores (P = 0.002). Delayed pubertal development correlated with whole body bone mineral density z scores (r = 0.64; P = 0.004). Most subjects were not meeting United States recommended dietary allowances for daily intake of calcium, vitamin D and total calories. The majority of subjects were not participating in weight-bearing physical activity.
Conclusion:
Decreased bone mass is common in steroid naive children newly diagnosed with Crohn disease. Crohn disease appears to contribute to impaired bone mass independent of corticosteroid therapy.
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