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Osteoporosis in pediatric patients suffering from chronic inflammatory bowel disease with and without steroid
Frank Walther1, Christoph Fusch, Michael Radke
1University Children's Hospital, Faculty of Medicine, University of Rostock, Rembrandtstrasse 16/17, D-18057 Rostock. frank.walther@med.uni-rostock.de
Insights
Pediatric inflammatory bowel disease (IBD) patients have similar osteoporosis rates whether or not they use steroids. Osteoporosis is present before steroid treatment, highlighting the need for accurate bone density measurements in these children.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Bone Metabolism
Background:
- Children with inflammatory bowel disease (IBD) face increased osteoporosis risk due to corticosteroids, inflammation, and malnutrition.
- Assessing osteoporosis in pediatric IBD is crucial due to potential long-term bone health consequences.
Purpose of the Study:
- To compare osteoporosis rates in steroid-naive versus steroid-treated pediatric IBD patients.
- To investigate the impact of inflammation and malnutrition on bone health in pediatric IBD.
Main Methods:
- Dual-energy X-ray absorptiometry (DXA) assessed lumbar spine bone mineral density (BMD) in 90 IBD patients and 52 controls.
- Areal BMD was converted to bone mineral apparent density (BMAD) and expressed as standard deviation scores (SDS) relative to controls.
Main Results:
- Osteoporosis (BMAD-SDS < -2) affected 8% of girls and 20% of boys.
- Osteoporosis prevalence was similar in steroid-naive (12%) and steroid-treated (11%) IBD patients.
- Body height SDS correlated with BMD-SDS, not BMAD-SDS, indicating bone size influences BMD measurements.
Conclusions:
- Osteoporosis is prevalent in pediatric IBD patients, mirroring adult rates, and exists before steroid therapy.
- Volumetric bone parameters (BMAD) are essential for accurate assessment, compensating for short stature in IBD patients.
- Accurate assessment using BMAD prevents misdiagnosis of osteopenia in growth-stunted pediatric IBD patients.
Background:
Children and adolescents suffering from inflammatory bowel disease (IBD) are at risk of developing osteoporosis as a result of treatment with corticosteroids as well as of nonsteroidal factors like inflammation and malnutrition. To study the impact of these factors on development of osteopathy, we compared the rate of osteoporosis in steroid-naive and steroid-treated pediatric IBD patients.
Methods:
In 90 patients (50 girls) with IBD (34 steroid-naive, 53 steroid-treated, 3 not known) aged 8.8 to 19.2 (14.4 +/- 2.2) years and 52 controls (27 girls) aged 6.1 to 17.6 (12.9 +/- 3.0) years, bone mineral density (BMD) of the lumbar spine was assessed with dual energy x-ray absorptiometry. Areal BMD values were transformed into volumetric densities called bone mineral apparent density (BMAD) and expressed as standard deviation scores (SDS) on the basis of the BMAD values of the controls.
Results:
The rate of osteoporotic patients (BMAD-SDS < -2) was 8% in girls and 20% in boys. There was a similar proportion of osteoporosis in steroid-naive (12%) and steroid-treated (11%) patients. SDS of body height showed a significant positive correlation with BMD-SDS but not with BMAD-SDS in almost all patient subgroups, indicating an interfering dependency of BMD from bone size.
Conclusions:
The prevalence of osteoporosis in pediatric patients with IBD is approximately the same as in adult patients. Osteoporosis is already present before steroid treatment. Data of dual energy x-ray absorptiometry measurements should be transformed into volumetric parameters to compensate for short stature. Otherwise, a lot of growth-stunted patients may be falsely diagnosed as osteopenic.
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