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Reduced muscle mass and bone size in pediatric patients with inflammatory bowel disease
Susanne Bechtold1, Martin Alberer, Tina Arenz
1Division of Pediatric Endocrinology, Dr. v. Haunersches Kinderspital, University, Munich, Germany.
Insights
Children with inflammatory bowel disease (IBD) show reduced bone density and muscle mass. Muscle wasting, present at diagnosis, appears to drive bone disease in pediatric IBD patients.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Bone Metabolism
Background:
- Children with inflammatory bowel disease (IBD) often exhibit decreased bone mineral density.
- Peripheral quantitative computed tomography (pQCT) is a valuable tool for assessing bone health in pediatric IBD.
Purpose of the Study:
- To evaluate bone mineralization, geometry, and muscle cross-sectional area (CSA) in pediatric IBD patients using pQCT.
- To investigate the relationship between bone health, muscle mass, and disease characteristics in pediatric IBD.
Main Methods:
- A cross-sectional study involving 143 pediatric IBD patients (mean age 13.9 years) using forearm pQCT.
- Data collected included auxological data, glucocorticoid dose, disease activity, inflammation markers, and bone metabolism markers.
Main Results:
- IBD patients showed reduced height, weight, muscle mass, and total bone CSA compared to healthy controls.
- Newly diagnosed patients had a higher bone mineral mass to muscle CSA ratio than those with longer disease duration.
- Serum albumin and disease activity correlated with muscle mass; trabecular bone mineral density was within the lower normal range.
Conclusions:
- Reduced bone geometry in pediatric IBD is partly due to decreased height and significantly linked to muscle wasting present at diagnosis.
- Muscle wasting appears to be the primary driver of bone disease in pediatric IBD.
- Serum albumin is a reliable marker for muscle wasting and abnormal bone development in pediatric IBD.
Background:
Decreased bone mineral density has been reported in children with inflammatory bowel disease (IBD). We used peripheral quantitative computed tomography (pQCT) to assess bone mineralization, geometry, and muscle cross-sectional area (CSA) in pediatric IBD.
Methods:
In a cross-sectional study, pQCT of the forearm was applied in 143 IBD patients (mean age 13.9 +/- 3.5 years); 29% were newly diagnosed, 98 had Crohn's disease, and 45 had ulcerative colitis. Auxological data, cumulative glucocorticoid dose, disease activity indices, laboratory markers for inflammation, and bone metabolism were related to the results of pQCT.
Results:
Patients were compromised in height (-0.82 +/- 1.1 SD), weight (-0.77 +/- 1.0 SD), muscle mass (-1.12 +/- 1.0 SD), and total bone cross-sectional area (-0.79 +/- 1.0 SD) compared to age- and sex-matched healthy controls (z-scores). In newly diagnosed patients, the ratio of bone mineral mass per muscle CSA was higher than in those with longer disease duration (1.00 versus 0.30, P = 0.007). Serum albumin level and disease activity correlated with muscle mass, accounting for 41.0% of variability in muscle mass (P < 0.01). The trabecular bone mineral density z-score was on average at the lower normal level (-0.40 +/- 1.3 SD, P < 0.05).
Conclusions:
Reduced bone geometry was explained only in part by reduced height. Bone disease in children with IBD seems to be secondary to muscle wasting, which is already present at diagnosis. With longer disease duration, bone adapts to the lower muscle CSA. Serum albumin concentration is a good marker for muscle wasting and abnormal bone development.
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