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Published on: January 29, 2018
Bone health in children with inflammatory bowel disease: adjusting for bone age
Rebecca J Hill1, Denise S K Brookes, Peter J Lewindon
1University of Queensland, Children's Nutrition Research Centre, Discipline of Paediatrics and Child Health, Royal Children's Hospital, Herston, QLD 4029, Australia. rj.hill@uq.edu.au
Insights
Bone age, not chronological age, is a better measure for bone mineral density in children with inflammatory bowel disease, especially Crohn disease. This improves accuracy in assessing bone health for these growing patients.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Radiology
Background:
- Children with inflammatory bowel disease (IBD), particularly Crohn disease, often experience growth and maturation delays.
- Current clinical assessments of bone mineral density (BMD) in these children typically rely on chronological age, which may not accurately reflect their developmental stage.
Purpose of the Study:
- To evaluate the appropriateness of using bone age versus chronological age for interpreting areal bone mineral density (aBMD) z scores in children with IBD.
- To determine if bone age improves the assessment of aBMD in pediatric IBD patients, specifically those with Crohn disease and ulcerative colitis.
Main Methods:
- Areal bone mineral density (aBMD) was measured using dual-energy x-ray absorptiometry (DXA).
- Bone age was determined using the Tanner-Whitehouse 3 (TW3) method from hand/wrist radiographs.
- aBMD measurements were converted to z scores using both chronological and bone ages for 44 children (ages 7.99–16.89 years).
Main Results:
- aBMD z scores were significantly improved when calculated using bone age compared to chronological age for both total body and lumbar spine regions.
- Bone age-adjusted z scores remained significantly improved for children with Crohn disease but not for those with ulcerative colitis.
- In children with Crohn disease, bone age yielded significantly higher z scores than chronological age in the older subgroup, but not the younger subgroup.
Conclusions:
- aBMD assessment in children with Crohn disease should incorporate bone age rather than solely chronological age for more accurate interpretation.
- Bone size is also a relevant factor for interpreting pediatric aBMD results, though less readily available.
Objectives:
Clinical results of bone mineral density for children with inflammatory bowel disease are commonly reported using reference data for chronological age. It is known that these children, particularly those with Crohn disease, experience delayed growth and maturation. Therefore, it is more appropriate to compare clinical results with bone age rather than chronological age.
Materials And Methods:
Areal bone mineral density (aBMD) was measured using dual energy x-ray absorptiometry, and bone age was assessed using the Tanner-Whitehouse 3 method from a standard hand/wrist radiograph. Results were available for 44 children ages 7.99 to 16.89 years. Areal bone mineral density measurements were converted to z scores using both chronological and bone ages for each subject.
Results:
Areal bone mineral density z scores calculated using bone age, as opposed to chronological age, were significantly improved for both the total body and lumbar spine regions of interest. When subjects were grouped according to diagnosis, bone age generated z scores remained significantly improved for those with Crohn disease but not for those diagnosed with ulcerative colitis. Grouping of children with Crohn disease into younger and older ages produced significantly higher z scores using bone age compared with chronological for the older age group, but not the younger age group.
Conclusions:
Our findings, in accordance with those presented in the literature, suggest that aBMD results in children with Crohn disease should include the consideration of bone age, rather than merely chronological age. Bone size, although not as easily available, would also be an important consideration for interpreting results in paediatric populations.
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