RANKL/OPG Axis and Bone Mineral Density in Pediatric Inflammatory Bowel Disease
Mariusz Olczyk1,2, Agnieszka Frankowska1, Marcin Tkaczyk1
1Department of Paediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, 90-419 Lodz, Poland.
Insights
Pediatric inflammatory bowel diseases (IBD) disrupt bone metabolism, altering the RANKL/OPG axis and reducing bone density. Early screening for skeletal health in children with IBD is recommended.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Bone Metabolism
Background:
- Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), can negatively impact bone metabolism in children.
- The RANKL/OPG axis is a critical regulator of bone turnover, but its role in pediatric IBD-related bone disturbances is not well-established.
- Limited data exist regarding bone metabolism and the RANKL/OPG axis in pediatric IBD patients.
Purpose of the Study:
- To investigate alterations in the RANKL/OPG axis in children with IBD.
- To assess bone mineral density (BMD) and its relationship with the RANKL/OPG axis in pediatric IBD.
- To identify potential biomarkers for skeletal health in children with IBD.
Main Methods:
- A prospective observational study involving 100 children (aged 4-18 years), with 72 diagnosed with IBD (27 CD, 45 UC) and 28 healthy controls.
- Evaluations included anthropometric measurements, biochemical markers of inflammation and bone turnover, and serum levels of RANKL and OPG.
- Bone mineral density (BMD) was assessed using Z-scores, and correlations between variables were analyzed.
Main Results:
- Children with CD exhibited significantly lower height and weight percentiles.
- Elevated serum RANKL and RANKL/OPG ratio were observed in IBD patients, particularly those with CD.
- IBD patients showed lower total body BMD Z-scores, with a notable percentage experiencing low BMD or values in the 'gray zone'.
Conclusions:
- Pediatric IBD is associated with significant dysregulation of the RANKL/OPG axis and reduced bone density.
- Findings suggest that the RANKL/OPG axis may serve as a potential biomarker for skeletal health in children with IBD.
- Early screening for bone health is warranted in pediatric IBD populations.
Abstract:
Background: Inflammatory bowel diseases (IBD), such as Crohn's disease (CD) and ulcerative colitis (UC), may impair bone metabolism, particularly in children. The RANKL/OPG axis, as a key regulator of bone turnover, may contribute to these disturbances. However, data in the pediatric population remain limited. Methods: A single-center, prospective observational study included 100 children aged 4-18 years, with a comparable number of girls and boys. Among them, 72 had IBD (27 CD, 45 UC) and 28 were healthy controls. Anthropometric, biochemical, and densitometric assessments were performed, including serum levels of RANKL and OPG, and markers of inflammation and bone turnover. Results: Children with CD had significantly lower height and weight percentiles compared to UC and controls. Serum RANKL and the RANKL/OPG ratio were significantly elevated in IBD patients, particularly in CD (p < 0.01). Total body BMD Z-scores were lower in IBD compared to controls (p = 0.03). Low BMD was found in 14.7% of UC and 26.3% of CD patients. In both groups, over 30% had values in the "gray zone" (-1.0 to -2.0). A positive correlation was observed between height and weight and bone density (p < 0.01). Higher OPG was associated with lower body weight (p < 0.001), while increased RANKL correlated with osteocalcin (p = 0.03). Patients receiving biological therapy had significantly lower BMD. Conclusions: Pediatric IBD is associated with significant alterations in the RANKL/OPG axis and reduced bone density. These findings support early screening and suggest RANKL/OPG as a potential biomarker of skeletal health.
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