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Published on: January 29, 2018
Low bone mineral density in children and adolescents with inflammatory bowel disease: a population-based study from
Susanne Schmidt1, Dan Mellström, Ensio Norjavaara
1Department of Pediatrics, Borås Central Hospital, Borås, Sweden. schm-sus@online.no
Insights
Low bone mineral density (BMD) is common in Swedish pediatric patients with inflammatory bowel disease (IBD). Male gender, low body mass index (BMI), and azathioprine treatment are linked to decreased BMD in these children.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Bone Metabolism
Background:
- Low bone mineral density (BMD) is a recognized complication in pediatric inflammatory bowel disease (IBD).
- Understanding BMD status and contributing factors in this population is crucial for early intervention.
Purpose of the Study:
- To assess BMD in Swedish children and adolescents diagnosed with IBD.
- To identify potential factors influencing BMD levels in pediatric IBD patients.
Main Methods:
- A cohort of 144 pediatric IBD patients underwent dual-energy X-ray absorptiometry (DXA) for whole body and spine BMD assessment.
- BMD values were standardized as Z-scores using pediatric reference data.
Main Results:
- Pediatric IBD patients exhibited significantly lower lumbar spine BMD Z-scores compared to healthy controls.
- Nearly half of the patients with Crohn's disease (CD) and ulcerative colitis (UC) presented with decreased BMD (Z-score < -1 SD).
- Male gender, low body mass index (BMI), and azathioprine treatment were independently associated with lower lumbar spine BMD.
Conclusions:
- Low BMD is prevalent among Swedish pediatric IBD patients.
- Male sex, low BMI, and azathioprine use are identified as risk factors for reduced BMD.
- Azathioprine may serve as an indicator of disease severity impacting bone health.
Background:
Low bone mineral density (BMD) has been recognized as a potential problem in children with inflammatory bowel disease (IBD). The aim of the study was to investigate BMD in Swedish children and adolescents with IBD and to evaluate possible factors affecting BMD.
Methods:
To evaluate BMD, all patients (n = 144) underwent a dual-energy X-ray absorptiometry (DXA) of the whole body and the spine. BMD values were expressed as Z-scores using normative pediatric data from Lunar (GE Medical Systems).
Results:
In this population-based study, the lowest BMD values were found in the lumbar spine. The entire IBD group showed significantly lower BMD Z-scores of the lumbar spine (L2-L4) in comparison to healthy references (-0.8 standard deviation [SD], range -5.9 to 3.7 SD, P < 0.001). Decreased BMD with a Z-score < -1 SD occurred in 46.7% of the individuals with Crohn's disease (CD) and in 47.0% of those with ulcerative colitis (UC). Low BMD with a Z-score ≤ -2 SD was present in 26.7% of the patients with CD and in 24.1% of the UC patients. In a multiple regression model with BMD lumbar spine as the depending variable, possible factors associated with lower BMD were male gender, low body mass index (BMI), and treatment with azathioprine.
Conclusions:
Low BMD is prevalent in Swedish pediatric patients with IBD. Possible risk factors for lower BMD are male gender, low BMI, and treatment with azathioprine, as a probable marker of disease course severity.
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