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Risk of diagnosed fractures in children with inflammatory bowel diseases
Michael D Kappelman1, Joseph A Galanko, Carol Q Porter
1Department of Pediatrics, Division of Pediatric Gastroenterology, University of North Carolina Chapel Hill, North Carolina 27599, USA. michael_kappelman@med.unc.edu
Insights
Children with inflammatory bowel disease (IBD) do not face a higher risk of diagnosed fractures compared to their peers. This study found no increased fracture risk associated with IBD, geographical region, or oral steroid use in pediatric patients.
Area of Science:
- Pediatric gastroenterology
- Bone health in chronic illness
- Epidemiology of childhood disease
Background:
- Children with inflammatory bowel disease (IBD) often experience reduced bone mass.
- Fracture risk in pediatric IBD patients remains largely uncharacterized.
- Investigating fracture risk factors, including geographical variations and steroid use, is crucial.
Purpose of the Study:
- To assess fracture risk in children diagnosed with Crohn's disease (CD) and ulcerative colitis (UC).
- To compare fracture incidence in pediatric IBD patients against age-, gender-, and region-matched controls.
- To determine the influence of geographical region and oral corticosteroid therapy on fracture risk in this population.
Main Methods:
- Utilized administrative data from 87 health plans to identify pediatric cases (<20 years) of CD and UC.
- Matched each IBD case with three controls based on age, gender, and geographical region.
- Identified fractures using ICD-9 codes and assessed oral steroid exposure via NDC codes.
Main Results:
- The study included 733 CD patients, 488 UC patients, and 3287 controls (mean age 15 years).
- No significant association was found between IBD (CD or UC) and an increased risk of fractures at any or multiple sites.
- Fracture rates did not differ significantly based on geographical region (Northeast/Midwest vs. South) or oral steroid use among IBD patients.
Conclusions:
- Pediatric patients diagnosed with IBD do not exhibit a higher likelihood of experiencing a diagnosed fracture compared to their matched controls.
- The findings suggest that IBD itself, geographical location, or oral steroid use are not significant independent risk factors for fractures in children.
- This research addresses a critical knowledge gap regarding bone health and fracture risk in the pediatric IBD population.
Background:
Decreased bone mass is common in children with inflammatory bowel disease (IBD); however, fracture risk is unknown. We sought to evaluate fracture risk in children with IBD as compared to unaffected controls and determine whether this risk is affected by geographical region (a proxy for sun/vitamin D exposure) and oral steroid use.
Methods:
We identified cases of Crohn's disease (CD) and ulcerative colitis (UC), less than 20 years of age, using administrative data from 87 health plans. Each case was matched to three controls on the basis of age, gender, and geographical region. We identified fractures in cases and controls using ICD-9 diagnosis codes and measured oral steroid exposure using NDC codes.
Results:
The study included 733 children with CD, 488 with UC, and 3287 controls (mean age 15 years). IBD was not associated with a higher risk of fracture at any site (CD odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6-1.1; UC OR 1.4, 95% CI 1.0-2.1) or at multiple sites (CD OR 0.8, 95% CI 0.4-1.7; UC OR 0.4, 95% CI 0.1-1.4). Among IBD patients we did not identify any significant differences in the fracture rate between those residing in the Northeast/Midwest versus the South (OR 1.3, 95% CI 0.8-2.2). Steroid exposure was not associated with the occurrence of fractures (P = 0.6).
Conclusions:
Children with IBD are no more likely to have experienced a diagnosed fracture than age-, sex-, and gender-matched controls.
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