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Inflammation is the main determinant of low bone mineral density in pediatric inflammatory bowel disease
Massimiliano Paganelli1, Carlina Albanese, Osvaldo Borrelli
1Pediatric Gastroenterology and Liver Unit, University of Rome La Sapienza, Rome Italy.
Insights
Inflammation, not steroids, significantly impacts bone density in pediatric inflammatory bowel disease (IBD). Infliximab (IFX) treatment showed a beneficial effect on bone mineral density (BMD) in Crohn
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Bone Metabolism
Background:
- Pediatric inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is associated with reduced bone mineral density (BMD).
- The roles of inflammation and corticosteroid therapy in pediatric IBD-related bone loss require further elucidation.
Purpose of the Study:
- To evaluate bone mineral density (BMD) in children diagnosed with Crohn's disease (CD) and ulcerative colitis (UC).
- To investigate the influence of inflammatory markers and steroid use on BMD in pediatric IBD patients.
Main Methods:
- Bone mineral density (BMD) of the lumbar spine was measured using dual-energy X-ray absorptiometry (DXA), and volumetric BMD (BMAD) was estimated.
- Serum levels of inflammatory cytokines (TNF-alpha, IL-6, IL-10, IL-12) were quantified, and cumulative and daily steroid doses were calculated.
- The impact of infliximab (IFX) therapy on BMD was assessed in CD patients.
Main Results:
- A significant inverse correlation was observed between BMAD and IL-6 in UC patients (r = -0.65) and between BMAD and disease activity indexes in both CD (r = -0.62) and UC (r = -0.64) patients.
- Patients with CD treated with IFX demonstrated higher BMAD compared to those not receiving IFX.
- Pediatric Crohn's Disease Activity Index and IL-6 levels were identified as independent predictors of BMAD in CD and UC, respectively.
Conclusions:
- Systemic inflammation, indicated by IL-6 levels and disease activity, is a key factor contributing to bone loss in pediatric IBD.
- Infliximab (IFX) therapy appears to have a positive impact on bone density in children with Crohn's disease.
- Corticosteroid use may play a less significant role in reducing BMD in pediatric IBD than previously assumed.
Aims:
To assess bone mineral density (BMD) in children with Crohn's disease (CD) and ulcerative colitis (UC) and to investigate the role of inflammation and steroids on BMD.
Methods:
Lumbar spine areal BMD was measured by DXA, and volumetric BMD was then estimated (BMAD); inflammatory cytokines (TNF-alpha, IL-6, IL-10, and IL-12) were dosed in peripheral blood; and cumulative and daily doses of steroids were calculated. Therapy with infliximab (IFX) was considered for CD patients.
Results:
Fifty-six patients with IBD (35 CD, 21 UC) were studied. An inverse correlation was found between BMAD and IL-6 in patients with UC (r = -0.65); no correlation was found between BMAD and serum levels of TNF-alpha, IL-10, and IL-12 in all patients. Disease activity indexes use inversely correlated with BMAD (r = -0.62 in patients with CD and r = -0.64 in patients with UC). Cumulative dose of corticosteroids and duration of therapy did not correlate with BMAD. The 10 patients with CD who were treated with IFX had higher BMAD (-1 +/- 0.8) than those never treated with IFX (-1.8 +/- 0.8). Mean Pediatric Crohn's Disease Activity Index and body mass index in patients with CD (R(2) = 0.48) and IL-6 level in patients with UC (R(2) = 0.43) were found to be independent and significant predictors of BMAD.
Conclusions:
In children with IBD, inflammation is an important determinant of bone loss, as shown by the correlation of BMAD with serum IL-6 and with disease activity indexes as well as by the beneficial effect of IFX on bone density. Corticosteroids seem to be a less important variable in pediatric IBD-related BMD reduction than previously believed.
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