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Impaired bone health in inflammatory bowel disease: a case-control study in 80 pediatric patients
Saila Laakso1, Helena Valta, Matti Verkasalo
1Children's Hospital, Helsinki University Central Hospital and University of Helsinki, P.O. Box 281, 00029 Helsinki, Finland. saila.laakso@helsinki.fi
Insights
Children with inflammatory bowel disease (IBD) show lower bone density and accrual, with increased fracture risk. These findings highlight the need for vigilant monitoring and proactive bone health interventions in pediatric IBD patients.
Area of Science:
- Pediatric Endocrinology
- Pediatric Gastroenterology
- Bone Metabolism
Background:
- Children with inflammatory bowel disease (IBD) may experience suboptimal bone mass development.
- Previous studies suggest a potential impact of IBD on skeletal maturity and bone mineral acquisition in pediatric populations.
- Understanding skeletal characteristics in pediatric IBD is crucial for long-term health outcomes.
Purpose of the Study:
- To evaluate the skeletal characteristics, including bone mineral density and vertebral fractures, in children and adolescents diagnosed with IBD.
- To correlate bone health parameters with disease duration, severity, and treatment modalities, particularly corticosteroid use.
- To compare skeletal parameters between IBD patients and age- and gender-matched healthy controls.
Main Methods:
- A cross-sectional cohort study involving 80 pediatric IBD patients (median age 14.9 years) and 80 healthy controls.
- Dual-energy X-ray absorptiometry (DXA) was used to assess areal bone mineral density (aBMD) and body composition.
- Vertebral fractures (VFs) were identified, and bone age (BA) was determined for IBD patients; data were correlated with clinical and biochemical parameters.
Main Results:
- IBD patients exhibited significantly lower BA-adjusted lumbar spine and whole-body aBMD, and height-adjusted whole-body bone mineral content (BMC) compared to controls.
- While lean and fat mass Z-scores were similar, IBD patients had lower whole-body BMC relative to muscle mass.
- Vitamin D deficiency was prevalent despite supplementation. Higher cumulative weight-adjusted prednisolone doses (>150 mg/kg over 3 years) were associated with increased risk of low whole-body aBMD. Vertebral fractures were more common in IBD patients (11%) than controls (3%).
Conclusions:
- Childhood IBD is associated with reduced bone mineral density and impaired bone mass accrual relative to muscle mass.
- There is an elevated risk of subclinical vertebral fractures in pediatric IBD patients.
- These findings underscore the necessity for diligent follow-up and implementation of preventive strategies to optimize bone health in children with IBD.
Abstract:
Previous studies have indicated that children with inflammatory bowel disease (IBD) may not achieve optimal bone mass. We evaluated the skeletal characteristics in children and adolescents with IBD. This cross-sectional cohort study comprised 80 IBD patients (median age 14.9 years, range 5-20) with a median disease duration of 3.4 years; 51 had ulcerative colitis, 26 Crohn disease, and 3 unspecified colitis. Eighty age- and gender-matched healthy subjects served as controls. Areal bone mineral density (aBMD), body composition, and vertebral fractures (VFs) were assessed by DXA. Bone age (BA) was determined for IBD patients. Findings were correlated with disease- and treatment-related parameters and biochemistry. IBD patients had lower BA-adjusted lumbar spine and whole-body aBMD (p < 0.001 for both) and whole-body BMC adjusted for height (p = 0.02) than controls. Lean mass and fat mass Z scores did not differ between the groups, but IBD patients had lower whole-body BMC relative to muscle mass (p = 0.006). Despite vitamin D supplementation in 48 %, vitamin D deficiency was common. In IBD cumulative weight-adjusted prednisolone dose >150 mg/kg for the preceding 3 years increased the risk for low whole-body aBMD (OR = 5.5, 95 % CI 1.3-23.3, p = 0.02). VFs were found in 11 % of patients and in 3 % of controls (p = 0.02). IBD in childhood was associated with low aBMD and reduced bone mass accrual relative to muscle mass; the risk for subclinical VFs may be increased. These observations warrant careful follow-up and active preventive measures.
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