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Bone mineral density assessment in children with inflammatory bowel disease
R Gokhale1, M J Favus, T Karrison
1Section of Pediatric Gastroenterology, University of Chicago, Chicago, Illinois 60614, USA.
Insights
Children with inflammatory bowel disease (IBD) have lower bone mineral density (BMD), particularly those with Crohn's disease. Corticosteroid use significantly predicts reduced BMD in these pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Bone Metabolism
Background:
- Children with inflammatory bowel disease (IBD) face increased osteoporosis risk due to malnutrition, delayed puberty, and corticosteroid use.
- Assessing bone mineral density (BMD) is crucial for managing IBD in children.
Purpose of the Study:
- To compare BMD in children with IBD versus healthy controls.
- To evaluate the impact of nutritional, hormonal, and corticosteroid factors on BMD in pediatric IBD.
Main Methods:
- 162 subjects (99 IBD, 63 controls) underwent anthropometric, pubertal, and bone age assessments.
- BMD measured by dual-energy x-ray absorptiometry (DXA) at lumbar spine, femoral neck, and radius.
- Extensive laboratory tests and cumulative corticosteroid doses were analyzed.
Main Results:
- Children with IBD exhibited lower BMD Z scores at the lumbar spine and femoral neck compared to controls.
- Crohn's disease patients had lower BMD than ulcerative colitis patients; low BMD persisted in girls with Crohn's disease.
- Cumulative corticosteroid dose was a significant predictor of reduced BMD; calcium homeostasis measures showed limited correlation.
Conclusions:
- Pediatric IBD patients, especially those with Crohn's disease and during puberty, have low BMD.
- Corticosteroid dose is a key factor, but other elements contributing to low BMD in Crohn's disease require further investigation.
Background & Aims:
Children with inflammatory bowel disease (IBD) are at risk for osteoporosis because of undernutrition, delayed puberty, and prolonged corticosteroid use. The aim of this study was to compare bone mineral density (BMD) in children with IBD with that in normal children and to assess the effects of nutritional and hormonal factors and corticosteroid dosages on BMD.
Methods:
One hundred sixty-two subjects (99 with IBD and 63 healthy sibling controls) were enrolled. Patients underwent anthropometric assessment, pubertal staging, bone age radiography, and BMD assessment by dual energy x-ray absorptiometry of the lumbar spine, femoral neck, and radius. Laboratory evaluations included serum calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, parathyroid hormone, osteocalcin, urinary N-telopeptides, albumin, insulin-like growth factor I, and testosterone or estradiol. Cumulative corticosteroid doses were calculated.
Results:
BMD Z scores at the lumbar spine and femoral neck were lower in patients with IBD, and lower in those with Crohn's disease compared with those with ulcerative colitis. Low BMD persisted after correction for bone age in girls with Crohn's disease (lumbar spine, P = 0.004; femoral neck, P = 0.002). Cumulative corticosteroid dose was a significant predictor of reduced BMD. BMD did not correlate with measures of calcium homeostasis, except elevated serum phosphate and urine calcium levels in girls.
Conclusions:
Low BMD occurs in children with IBD (more in Crohn's disease than in ulcerative colitis), especially pubertal and postpubertal girls. Cumulative corticosteroid dose is a predictor of low BMD, but other factors in Crohn's disease remain undetermined.
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