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Bone mineral density and nutritional status in children with chronic inflammatory bowel disease
A M Boot1, J Bouquet, E P Krenning
1Department of Paediatrics, Erasmus University, Rotterdam, The Netherlands.
Insights
Children with inflammatory bowel disease (IBD) have lower bone mineral density (BMD). Crohn's disease patients face a higher risk of osteopenia than ulcerative colitis patients, with corticosteroid use and nutrition impacting BMD.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Metabolic Bone Disease
Background:
- Osteoporosis is a known complication in adult inflammatory bowel disease (IBD) patients.
- Limited data exists on bone health in pediatric IBD populations.
- Evaluating bone mineral density (BMD) in children with IBD is crucial.
Purpose of the Study:
- To assess bone mineral density (BMD) in children diagnosed with inflammatory bowel disease (IBD).
- To evaluate the nutritional status and identify determinants of BMD in pediatric IBD patients.
- To compare BMD between children with Crohn's disease and ulcerative colitis.
Main Methods:
- Dual-energy X-ray absorptiometry (DXA) was used to measure lumbar spine and total body BMD and body composition in 55 children (ages 4-18).
- Bioelectrical impedance analysis (BIA) assessed lean body mass.
- Measurements were taken at baseline and annually for two years in a subset of patients.
Main Results:
- Children with IBD exhibited significantly lower mean lumbar spine and total body BMD standard deviation scores (SDS) compared to normal values.
- Decreased height SDS and body mass index SDS were observed; bone maturation delay did not explain the reduced BMD.
- Cumulative corticosteroid (prednisolone) dose negatively correlated with BMD, while body mass index SDS positively correlated with total body BMD. Crohn's disease patients had lower BMD than ulcerative colitis patients, even after adjusting for prednisolone.
- Longitudinal data showed a negative correlation between cumulative prednisolone dose and changes in BMD.
Conclusions:
- Pediatric patients with inflammatory bowel disease (IBD) demonstrate reduced bone mineral density (BMD).
- Children with Crohn's disease have a greater risk of developing osteopenia compared to those with ulcerative colitis.
- Corticosteroid therapy and nutritional status are significant factors influencing BMD in pediatric IBD.
Background:
Osteoporosis has been reported in adult patients with inflammatory bowel disease.
Aims:
To evaluate bone mineral density (BMD), nutritional status, and determinants of BMD in children with inflammatory bowel disease.
Patients:
Fifty five patients (34 boys and 21 girls, age range 4-18) were studied; 22 had Crohn's disease and 33 ulcerative colitis.
Methods:
Lumbar spine and total body BMD, and body composition were assessed by dual energy x ray absorptiometry (DXA). Results were expressed as standard deviation scores (SDS). Lean body mass was also assessed by bioelectrical impedance analysis (BIA). Yearly measurements during two years were performed in 21 patients.
Results:
The mean SDS of lumbar spine BMD and total body BMD were significantly lower than normal (-0.75 and -0.95, both p < 0.001). Height SDS and body mass index SDS were also decreased. The decrease in BMD SDS could not be explained by delay in bone maturation. The cumulative dose of prednisolone correlated negatively with lumbar spine BMD SDS (r = -0.32, p < 0.02). Body mass index SDS correlated positively with total body BMD SDS (r = 0.36, p < 0.02). Patients with Crohn's disease had significantly lower lumbar spine and total body BMD SDS than patients with ulcerative colitis, even after adjustment for cumulative dose of prednisolone. In the longitudinal data cumulative dose of prednisolone between the measurements correlated negatively with the change in lumbar spine and total body BMD SDS. Lean tissue mass measured by DXA had a strong correlation with lean body mass measured by BIA (r = 0.98).
Conclusions:
Children with inflammatory bowel disease have a decreased BMD. Children with Crohn's disease have a higher risk of developing osteopaenia than children with ulcerative colitis. Corticosteroid therapy and nutritional status are important determinants of BMD in these patients.
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