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Use of Dual-Energy X-ray Absorptiometry in Children with Inflammatory Bowel Disease: A Large Single Centre Study
Asha Jois1, Sajini Perera2, Peter Simm3
1Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Victoria, Australia.
Insights
Children with inflammatory bowel disease (IBD) often have low bone mineral density (BMD). Fecal calprotectin (FCP) levels, along with height and weight, are associated with lower BMD and should inform dual-energy x-ray absorptiometry (DXA) screening guidelines.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Radiology
Background:
- Low bone mineral density (BMD) is a known complication in pediatric inflammatory bowel disease (IBD).
- Limited data exist on the effectiveness of dual-energy x-ray absorptiometry (DXA) for screening low BMD in this population.
- This study retrospectively analyzed DXA utilization in children with IBD.
Purpose of the Study:
- To evaluate the use of dual-energy x-ray absorptiometry (DXA) as a screening tool for low bone mineral density (BMD) in children with inflammatory bowel disease (IBD).
- To identify factors associated with low BMD in this cohort.
Main Methods:
- Retrospective analysis of children aged 5-18 years with IBD diagnosed between 2013-2017.
- Collection of patient demographics, disease activity measures, DXA scores, and BMD-related factors.
- Analysis of lumbar spine (LS) z-scores and their correlation with weight, height, and fecal calprotectin (FCP).
Main Results:
- 30.1% of children underwent DXA, with 11.7% having a second scan; screening and surveillance practices deviated from consensus guidelines.
- Children with LS z-score ≤ -2.0 had significantly lower weight and height centiles and higher FCP levels.
- No fractures were reported, and no significant change in z-scores was observed upon repeat DXA.
Conclusions:
- Children with IBD exhibit low BMD, with FCP, height, and weight being associated factors.
- Current DXA screening practices do not consistently follow consensus guidelines.
- Increased clinician awareness of guidelines and further prospective studies are recommended.
Purpose:
Low bone mineral density (BMD) is a complication in children with inflammatory bowel disease (IBD). There are limited data evaluating dual-energy x-ray absorptiometry (DXA) as a screening tool for low BMD in children with IBD. We performed a single site retrospective analysis of DXA use.
Methods:
Children aged 5-18 years with IBD diagnosed between 2013 to 2017 at the Royal Children's Hospital, Australia, were included. Patient demographics, measures of disease activity, DXA scores, and factors related to BMD were collected.
Results:
Over a median follow up of 5.1 (4-6.4) years, 72/239 (30.1%) children underwent DXA, and 28/239 (11.7%) children had a second DXA. Our DXA practice differed to consensus guidelines regarding initial screening based on height and/or body mass index (BMI) z-score (8/17 [47.1%]), and repeat surveillance (13/42 [31.0%]). Children had a median lumbar spine (LS) z-score -0.80 (-1.65-0.075). Children with LS z-score≤-2.0 (n=14) had lower weight (6.57 [1.78-23.7] vs. 51.1 [26.5-68.7], p=0.0002) and height centiles (3.62 [1.17-17.1] vs. 42 [16.9-67.1], p=0.0001), and higher faecal calprotectin (FCP) (3041 [1182-4192] vs. 585 [139-2419], p=0.009) compared to children with LS z-score>-2.0. No fractures were reported. Of 28 children who underwent a second DXA 1.6 (1.1-2.2) years following initial DXA, no significant change in z-scores occurred.
Conclusion:
Children with IBD had low BMD. In addition to height centile and weight centile, FCP was associated with lower BMD, and should be considered in DXA screening guidelines. Greater clinician awareness of DXA consensus guidelines is required. Future prospective studies are required.
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