Related Experiment Video
Updated: May 9, 2025
Chronic Salmonella Infection Induced Intestinal Fibrosis
Published on: September 22, 2019
Prevalence and predictors of low bone mineral density in pediatric inflammatory bowel disease
Sharmistha Rudra1,2, Kanak Kennedy1, Sarah Neukrug1
1Division of Gastroenterology, Hepatology, & Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Low bone mineral density (BMD) affects 7% of pediatric patients with inflammatory bowel disease (IBD). Lower BMI and height Z-scores are key predictors, suggesting a need for regular BMD monitoring in this population.
Area of Science:
- Pediatric Gastroenterology
- Bone Metabolism
- Inflammatory Bowel Disease Research
Background:
- Bone health is a significant concern for children and young adults diagnosed with inflammatory bowel disease (IBD).
- Inflammatory bowel disease (IBD) can negatively impact bone mineral density (BMD) due to various factors including inflammation, nutritional deficiencies, and medication side effects.
Purpose of the Study:
- To determine the prevalence of low bone mineral density (BMD) in a cohort of pediatric and young adult patients with IBD.
- To identify clinical and genetic predictors associated with diminished bone health in this population.
Main Methods:
- A retrospective analysis of 600 patients (ages 3.5-22) with IBD who underwent dual-energy X-ray absorptiometry (DXA) scans between 2006 and 2019.
- Logistic regression identified predictors of low BMD (Z-scores ≤ -2 SD), while linear regression examined associations between genetic risk scores and BMD in a subset of 378 patients.
Main Results:
- The prevalence of low BMD, assessed by spine bone mineral apparent density (BMAD), was 7% in the study cohort.
- Lower BMI Z-scores (OR: 0.67) and decreased height Z-scores (OR: 0.6) were significant predictors of low BMAD.
- In a longitudinal subset, low BMI (OR: 0.44) and steroid use (OR: 3.42) were linked to suboptimal bone health (Z-scores ≤ -1 SD), and genetic risk for bone health was associated with BMD.
Conclusions:
- Lower body mass index (BMI) in pediatric IBD patients warrants dual-energy X-ray absorptiometry (DXA) monitoring for bone density.
- Genetic predisposition may help identify a specific subpopulation of pediatric IBD patients at higher risk for diminished bone health.
Objectives:
Bone health is at risk in children with inflammatory bowel disease (IBD). This study examined the prevalence and predictors of low bone mineral density (BMD) in a cohort of children and young adults with IBD.
Methods:
This single-center retrospective study included patients with IBD, ages 3.5-22 years, with completed dual x-ray absorptiometry (DXA) scans from 2006 to 2019. Demographic, clinical, and laboratory data were collected. Logistic regression analysis identified predictors associated with low BMD (Z-scores ≤ -2 standard deviations [SDs]) for three outcomes. In an overlapping IBD cohort with available genetic data between 2002 and 2019 (n = 378), genetic risk for diminished bone health was calculated using published polygenic risk scores generated from genome-wide association studies based on DXA or heel ultrasound speed of sound (SOS). Linear regression analysis examined associations of low BMD and genetic risk.
Results:
Low BMD prevalence was 7% in our cohort (n = 600) based on spine bone mineral apparent density (BMAD), which best accounts for growth delays. Median (interquartile range [IQR]) spine BMAD Z-score was -0.37 SD (-1.11 to 0.35). Predictors of low BMAD included lower BMI Z-score (odds ratio [OR]: 0.67, p value: 0.02) and decreased height Z-score (OR: 0.6, p value: 0.005). Of those with longitudinal data (n = 118), low BMI (OR: 0.44, p value: <0.001) and steroid use (OR: 3.42, p value: 0.01) were associated with suboptimal bone health (Z-scores ≤ -1SD). In the cohort with genetic data, heel genomic SOS (β [standard error] = 0.17 [0.35], p ≤ 0.01) was associated with BMD.
Conclusions:
Lower BMI should prompt DXA monitoring in pediatric IBD. Genetic predisposition may identify an at-risk subpopulation.
Related Concept Videos
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
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...
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...