Related Experiment Video
Updated: Apr 14, 2026
Effect of Anti-c-fms Antibody on Osteoclast Formation and Proliferation of Osteoclast Precursor In Vitro
Published on: March 18, 2019
Improvements in Bone Density and Structure during Anti-TNF-α Therapy in Pediatric Crohn's Disease
Lindsay M Griffin1, Meena Thayu1, Robert N Baldassano1
1Department of Radiology (L.M.G.), New York University School of Medicine, New York, New York 10016; Janssen Pharmaceuticals (M.T.), Titusville, New Jersey 08560; Department of Pediatrics (R.N.B., B.S.Z., M.R.D., J.S., R.H., J.L., M.B.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Pediatrics (M.D.D.), University of Virginia Health System, Charlottesville, Virginia 22908; Department of Pediatrics (L.A.D.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229; Department of Biostatistics and Epidemiology (J.S., M.B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; and Department of Pediatrics (M.B.L.), Stanford University Medical Center, Stanford, California 94025.
Insights
Anti-TNF-α therapy improved bone density and structure in pediatric Crohn's Disease (CD) patients. Younger patients showed greater bone gains, indicating a critical treatment window for bone deficits.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Bone Biology
Background:
- Pediatric Crohn's Disease (CD) is linked to reduced bone mineral density (BMD) and altered bone structure.
- Tumor Necrosis Factor-alpha (TNF-α) may negatively impact bone formation and promote resorption in pediatric CD.
Purpose of the Study:
- To evaluate bone density and structural changes in children and adolescents with CD after starting anti-TNF-α therapy.
- To assess the impact of anti-TNF-α therapy on musculoskeletal health in pediatric CD.
Main Methods:
- A 12-month prospective cohort study involving 74 pediatric CD patients (age 5-21 years).
- Peripheral quantitative computed tomography (pQCT) of the tibia was performed at baseline and 12 months.
- Musculoskeletal outcomes were compared to sex- and race-specific z scores from a reference population.
Main Results:
- Baseline CD patients exhibited lower height, trabecular BMD, cortical area, and muscle area z scores compared to controls.
- Anti-TNF-α therapy led to significant improvements in height, trabecular BMD, cortical area, and muscle area over 12 months.
- Increased bone-specific alkaline phosphatase levels correlated with improved bone density and structure; younger age predicted greater improvements.
Conclusions:
- Anti-TNF-α therapy is associated with significant improvements in bone density and cortical structure in pediatric CD.
- Younger, growing patients experienced greater benefits, highlighting a potential therapeutic window for addressing bone deficits.
Context:
Pediatric Crohn's Disease (CD) is associated with deficits in trabecular bone mineral density (BMD) and cortical structure, potentially related to TNF-α effects to decrease bone formation and promote bone resorption.
Objective:
This study aimed to examine changes in bone density and structure in children and adolescents with CD following initiation of anti-TNF-α therapy.
Design And Participants:
Participants (n = 74; age 5-21 years) with CD completed a 12-month prospective cohort study.
Main Outcome Measures:
Tibia peripheral quantitative computed tomography scans were obtained at initiation of anti-TNF-α therapy and 12 months later. Musculoskeletal outcomes were expressed as sex-and race-specific z scores relative to age, based on >650 reference participants.
Results:
At baseline, CD participants had lower height, trabecular BMD, cortical area (due to smaller periosteal and larger endocortical circumferences), and muscle area z scores, compared with reference participants (all P < .01). Pediatric CD activity index decreased during the 10-week induction (P < .001), in association with subsequent gains in height, trabecular BMD, cortical area (due to recovery of endocortical bone), and muscle area z scores over 12 months (height P < .05; others P < .001). Bone-specific alkaline phosphatase levels, a biomarker of bone formation, increased a median of 75% (P < .001) during induction with associated 12-month improvements in trabecular BMD and cortical area z scores (both P < .001). Younger age was associated with greater increases in trabecular BMD z scores (P < .001) and greater linear growth with greater recovery of cortical area (P < .001).
Conclusions:
Anti-TNF-α therapy was associated with improvements in trabecular BMD and cortical structure. Improvements were greater in younger and growing participants, suggesting a window of opportunity for treatment of bone deficits.
More Related Videos
Related Concept Videos
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
01:22Connective Tissue Cell Types
Fat cells (adipocytes), smooth muscle cells (myoblasts), and bone cells (osteoblasts) are some connective tissue cell types. Some immune system cells...