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Published on: September 20, 2018
Risk factors for low bone mineral density in pediatric inflammatory bowel disease: the positive role of physical
Stefano Nobile1, Richard J Grand2, Helen M Pappa3
1Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy.
Insights
Pediatric inflammatory bowel disease (IBD) patients show low bone mineral density (BMD) and fractures. Physical activity positively impacts BMD, while menstrual irregularities and tube feeding are associated with lower BMD.
Area of Science:
- Pediatric Gastroenterology
- Bone Metabolism
- Inflammatory Bowel Disease Research
Background:
- Pediatric inflammatory bowel disease (IBD) presents challenges in bone health, with debated prevalence of low bone mineral density (BMD) and fractures.
- Understanding the relationship between low BMD and fractures in pediatric IBD is crucial for effective management.
Purpose of the Study:
- To assess the prevalence of low BMD and bone fractures in a cohort of pediatric IBD patients.
- To identify clinical associations and risk factors related to BMD and fractures in this population.
Main Methods:
- Cross-sectional study involving growth assessment and dual-energy x-ray absorptiometry (DXA) for BMD measurement.
- Retrospective chart review to determine lifetime fracture prevalence and clinical data.
Main Results:
- Low BMD was observed in 12.5% (spine) and 27% (total body) of 216 pediatric IBD patients (8-25 years).
- Lifetime fracture prevalence was 11.8%. Patients with fractures had significantly lower spine and total-body BMD Z-scores.
- Factors associated with lower BMD included menstrual irregularities and nasogastric tube feeding, while physical activity and height Z-scores were linked to higher BMD.
Conclusions:
- This study highlights significant associations between low BMD and fractures in pediatric IBD.
- Physical activity emerges as a positive factor for BMD in pediatric IBD patients.
- Identified risk factors provide insights for targeted interventions to improve bone health in pediatric IBD.
Objective:
In pediatric inflammatory bowel disease (IBD), the prevalence of low bone mineral density (BMD) and bone fractures and the relationship between these are still debated. Our aim was to report data from a cohort of pediatric patients with IBD.
Patients And Methods:
Cross-sectional assessment of growth and BMD [(dual-energy x-ray absorptiometry (DXA)] and retrospective chart review were performed to report the lifetime prevalence of bone fractures and clinical associations with patients' data.
Results:
We examined 216 patients with IBD, 8-25 years old (median: 14 years). Low BMD was found in 12.5% (spine) and 27% (total body). Multiple regression analysis showed that BMD was predicted by Z-scores for height and weight at DXA. History of menstrual irregularities and nasogastric tube feedings was associated with lower BMD, whereas physical activity and higher Z-score for height at DXA were associated with higher BMD.The prevalence of lifetime fractures was 11.8%. Patients with a history of fractures had lower Z-scores for spine BMD (-1.20 vs. -0.69, P=0.020) and total-body BMD (-1.30 vs. -0.75, P=0.014) compared with those without a history of fractures. Patients with spine BMD Z-score of up to -2 SD score had significantly increased prevalence of fractures compared with those with Z-score more than -2 SD score (28 vs. 10%, P=0.015).
Conclusion:
This study provides further insight into risk factors for low BMD in pediatric IBD. Novel findings were the association between low BMD and fractures, and the positive relationship between BMD and physical activity.
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