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Fibroblast growth factor 23 contributes to diminished bone mineral density in childhood inflammatory bowel disease
Mostafa Abdel-Aziz El-Hodhod1, Ahmad Mohamed Hamdy, Amal Ahmed Abbas
1Department Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt. moshodhod@yahoo.com
Insights
Pediatric inflammatory bowel disease (IBD) is linked to low bone mineral density (BMD). Elevated fibroblast growth factor 23 (FGF23) is a new factor contributing to reduced BMD in children with IBD.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Bone Metabolism
Background:
- Diminished bone mineral density (BMD) is a significant concern in pediatric inflammatory bowel disease (IBD).
- The exact etiology of low BMD in pediatric IBD is not fully understood.
- Fibroblast growth factor 23 (FGF23), a phosphaturic hormone, is implicated due to its relationship with tumor necrosis factor alpha (TNF-α).
Purpose of the Study:
- To investigate the relationship between fibroblast growth factor 23 (FGF23) and bone mineral density (BMD) in children with inflammatory bowel disease (IBD).
- To assess changes in BMD and serum FGF23 levels during disease flare and remission in pediatric IBD patients.
Main Methods:
- A follow-up case control study involving 47 children with IBD.
- Measurement of BMD and serum levels of FGF23, calcium, phosphorus, alkaline phosphatase, creatinine, parathyroid hormone, 25 hydroxy vitamin D3, and 1, 25 dihydroxy vitamin D3.
- Assessment during disease flare and reassessment during subsequent remission.
Main Results:
- Low BMD was prevalent during IBD flare (87.2%), improving significantly in remission (44.7%).
- Serum FGF23 levels were significantly higher in IBD patients during flare compared to controls, decreasing in remission but not reaching control levels.
- 1,25 dihydroxy vitamin D3, FGF23, serum calcium, and urinary phosphorus were significant determinants of BMD in pediatric IBD patients.
Conclusions:
- Diminished BMD in childhood IBD is a common, multifactorial issue.
- Elevated FGF23 is identified as a novel factor contributing to reduced BMD in pediatric IBD.
- Further molecular research is needed to elucidate the interplay of these factors in pediatric IBD bone health.
Background:
Diminished bone mineral density (BMD) is of significant concern in pediatric inflammatory bowel disease (IBD). Exact etiology is debatable. The recognition of fibroblast growth factor 23 (FGF23), a phosphaturic hormone related to tumor necrosis factor alpha (TNF-α) makes it plausible to hypothesize its possible relation to this pathology.
Methods:
In this follow up case control study, BMD as well as serum levels of FGF23, calcium, phosphorus, alkaline phosphatase, creatinine, parathyroid hormone, 25 hydroxy vitamin D3 and 1, 25 dihydroxy vitamin D3 were measured in 47 children with IBD during flare and reassessed in the next remission.
Results:
Low BMD was frequent during IBD flare (87.2%) with significant improvement after remission (44.7%). During disease flare, only 21.3% of patients had vitamin D deficiency, which was severe in 12.8%. During remission, all patients had normal vitamin D except for two patients with Crohn's disease (CD) who remained vitamin D deficient. Mean value of serum FGF23 was significantly higher among patients with IBD during flare compared to controls. It showed significant improvement during remission but not to the control values. 1, 25 dihydroxy vitamin D3, FGF23, serum calcium and urinary phosphorus were significant determinants of BMD in IBD patients.
Conclusions:
We can conclude that diminished BMD in childhood IBD is a common multifactorial problem. Elevated FGF23 would be a novel addition to the list of factors affecting bone mineral density in this context. Further molecular studies are warranted to display the exact interplay of these factors.
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