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Musculoskeletal health in newly diagnosed children with Crohn's disease
Insights
Newly diagnosed pediatric Crohn's disease (CD) patients exhibit significant muscle and bone deficits. Despite these deficits, vertebral fractures are uncommon at diagnosis, indicating a need for early musculoskeletal monitoring in children with CD.
Area of Science:
- Pediatric rheumatology
- Pediatric gastroenterology
- Pediatric endocrinology
Background:
- Crohn's disease (CD) is a chronic inflammatory condition impacting the gastrointestinal tract.
- CD can lead to significant musculoskeletal complications, affecting bone and muscle health.
- Early assessment of these complications in pediatric CD is crucial for long-term outcomes.
Purpose of the Study:
- To evaluate the effects of newly diagnosed Crohn's disease on children's musculoskeletal system.
- To determine the prevalence of vertebral fractures in this pediatric population.
- To assess muscle and bone mass, strength, density, and geometry in children with newly diagnosed CD.
Main Methods:
- Seventy-three children diagnosed with CD underwent assessment within 35 days of diagnosis.
- Lateral spine radiography was used to detect vertebral fractures.
- Jumping mechanography, dual-energy x-ray absorptiometry, and peripheral quantitative computed tomography (pQCT) evaluated muscle and bone parameters.
Main Results:
- Children with newly diagnosed CD showed significantly low height, weight, BMI, and lean mass.
- Bone mineral density and content were reduced, with pQCT revealing compromised bone structure.
- Muscle strength and calf muscle cross-sectional area were diminished, despite a low prevalence of vertebral fractures (1 patient).
Conclusions:
- Children newly diagnosed with Crohn's disease experience substantial deficits in muscle and bone health.
- These deficits manifest as reduced mass, density, strength, and altered geometry.
- Vertebral fractures are infrequent at the time of diagnosis in pediatric CD.
Abstract:
We evaluated the impact of Crohn's disease on muscle and bone strength, mass, density, and geometry in children with newly diagnosed CD and found profound muscle and bone deficits; nevertheless, the prevalence of vertebral fractures at this time point was low.
Introduction:
Crohn's disease (CD) is an inflammatory condition of the gastrointestinal tract that can affect the musculoskeletal system. The objective of this study was to determine the prevalence of vertebral fractures and the impact of CD on muscle and bone mass, strength, density, and geometry in children with newly diagnosed CD.
Methods:
Seventy-three children (26 girls) aged 7.0 to 17.7 years were examined within 35 days following CD diagnosis by lateral spine radiograph for vertebral fractures and by jumping mechanography for muscle strength. Bone and muscle mass, density, and geometry were assessed by dual-energy x-ray absorptiometry and peripheral quantitative computed tomography (pQCT).
Results:
Disease activity was moderate to severe in 66 (90%) patients. Mean height (Z-score -0.3, standard deviation (SD) 1.1, p = 0.02), weight (Z-score -0.8, SD 1.3, p < 0.01), body mass index (Z-score -1.0, SD 1.3, p < 0.01), lumbar spine areal bone mineral density (BMD; Z-score -1.1, SD 1.0, p < 0.01), total body bone mineral content (Z-score -1.5, SD 1.0, p < 0.01), and total body lean mass (Z-score -2.5, SD 1.1, p < 0.01) were all low for age and gender. pQCT showed reduced trabecular volumetric BMD at the tibial metaphysis, expansion of the bone marrow cavity and thin cortices at the diaphysis, and low calf muscle cross-sectional area. Jumping mechanography demonstrated low muscle power. Only one patient had a vertebral fracture.
Conclusions:
Children with newly diagnosed CD have profound muscle and bone deficits; nevertheless, the prevalence of vertebral fractures at this time point was low.
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