Pathological fractures in paediatric patients with inflammatory bowel disease

Wong, Sze Choong; Catto‐Smith, Anthony G.; Zacharin, Margaret

doi:10.1007/s00431-013-2174-5

Cited by 33 publications

(21 citation statements)

References 101 publications

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“…Although generally treated with medical therapy, the occasional requirement for surgery as a specific treatment of IBD- related spondyloarthropathies could increase the likelihood that patients with IBD will undergo orthopedic surgery. Patients with IBD also have up to a 40% greater risk of bone fractures and a higher prevalence of osteoporosis compared to the general population[1,4-6,8]. Avascular necrosis of the hip may also occur in patients with IBD receiving corticosteroid treatment[2,7,8].…”

Section: Discussionmentioning

confidence: 99%

Hospital costs, length of stay and prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease

Ehrenpreis¹,

Zhou²

2017

WJG

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AIMTo examined the prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease (IBD) by comparing the diagnostic codes for these procedures in patients with IBD and a control group of patients.METHODSThe National Inpatient Sample database (NIS) is part of the Healthcare Cost and Utilization Project (HCUP), the largest publicly available inpatient healthcare database in the United States. The NIS samples about 20% of discharges from all community hospitals participating in HCUP, representative of more than 95% of the United States population, with approximately 7000000 hospitalizations reported annually. NIS contains data on diagnoses, procedures, demographics, length of stay (LOS), co-morbidities and outcomes. ICD-9-CM diagnostic codes for primary hospitalizations for arthroplasty of the hip or knee with a co-diagnosis of IBD [combining both Crohn’s disease (CD) and ulcerative colitis (UC)] were used to identify study subjects for cost and LOS analysis for NIS from 1999-2012. Statistical analysis: 1: 2 propensity score matching between IBD vs a control group based on following factors: Patient age, gender, race, total co-morbidities, # of procedures, admission type, insurance, income quartiles, and hospital bed size, location and hospital teaching status. Categorical variables were reported as frequency and compared by χ2 tests or Fisher’s exact tests. Individual 1:3 matching was also performed for patients carrying diagnostic codes for CD and for patients with the diagnostic code for UC. After matching, continuous variables were rcompared with Wilcoxon signed rank or Paired T-tests. Binary outcomes were compared with the McNemar’s test. This process was performed for the diagnosis of hip or knee arthroplasty and IBD (CD and UC combined). Prevalence of the primary or secondary diagnostic codes for these procedures in patients with IBD was determined from NIS 2007.RESULTSCosts and mortality were similar for patients with IBD and controls, but LOS was significantly longer for hip arthroplasties patients with IBD, (3.85 +/-2.59 d vs 3.68 +/-2.54 d, respectively, P = 0.009). Costs, LOS and survival from the procedures was similar in patients with CD and UC compared to matched controls. These results are shown in Tables 1-10. The prevalence of hip arthroplasty in patients with IBD was 0.5% in 2007, (170/33783 total patients with diagnostic codes for IBD) and was 0.66% in matched controls (P = 0.0012). The prevalence of knee arthroplasty in patients with IBD was 1.36, (292/21202 IBD patients) and was 2.22% in matched controls (P < 0.0001).CONCLUSIONCosts and mortality rates for hip and knee arthroplasties are the same in patients with IBD and the general population, while a statistical but non-relevant increase in LOS is seen for hip arthroplasties in patients with IBD. Compared to the general population, arthroplasties of the hip and knee are less prevalent in hospitalized patients with IBD.

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Section: Discussionmentioning

confidence: 99%

Hospital costs, length of stay and prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease

Ehrenpreis¹,

Zhou²

2017

WJG

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“…Of these, IL-1, IL-6, and TNF-α stimulate osteoclastogenesis, resulting in impaired bone metabolism [3]. Lower bone mineral density (BMD) and higher risk of fracture are indeed common in IBD patients, even among those not receiving treatment with glucocorticoids [4,5]. Thus, the inflammatory process itself causes deterioration of bone health, and bone health may be further compromised with glucocorticoid treatment.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Vitamin D3 Supplementation Does Not Prevent Colonic Inflammation or Modulate Bone Health in IL-10 Knockout Mice at Young Adulthood

et al. 2014

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Inflammatory bowel disease (IBD) is an idiopathic disease that can impair bone metabolism. Low vitamin D status has been implicated in its progress. This study used interleukin (IL)-10 knockout (KO) mice, that develop an intestinal inflammation when housed in a non-sterile environment, to determine if supplementation with vitamin D3 throughout life could mitigate inflammation and attenuate the lower bone mineral content (BMC) and density (BMD), and bone strength. Female IL-10 KO mice were randomized 25 or 5000 IU vitamin D3/kg diet throughout pregnancy and lactation. At weaning, offspring received the same or opposite diet as their mother until age three months. Body weight growth was similar among groups within a sex. At three months of age, there were no differences in inflammation and gene expression in the colon of offspring. Male offspring exposed to continuous 25 IU vitamin D3/kg diet had lower (p < 0.001) colonic VDR expression and those exposed only to low vitamin D3 until weaning had higher serum IL-6. There were no differences in femur or vertebral BMC, BMD or bone strength. In summary, long-term exposure to vitamin D3 did not attenuate intestinal inflammation or preserve bone mineral or bone strength. Thus, supplementation with vitamin D3 does not exert anti-inflammatory effects in this mouse model that mimics human inflammatory bowel disease.

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“…Skeletal fragility in childhood due to chronic disease is a systemic disorder of abnormal bone growth leading to abnormal bone mass, geometry and microarchitecture, which can lead to pathological fractures in childhood or later on in life [1,2]. Linear growth is a major driver of periosteal apposition by which bones can increase in length and width and, therefore, improvement of bone strength [3].…”

Section: Introductionmentioning

confidence: 99%

Skeletal Fragility in Children with Chronic Disease

2016

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Skeletal fragility associated with underlying childhood chronic disease is a systemic disorder of poor bone growth and reduction in bone turnover which can lead to abnormal bone mass, geometry and microarchitecture. Due to the growth potential unique to children, remarkable bone recovery following a transient threat to the bone can occur if there is concurrent growth. Addressing bone health in these children should focus on improvement in growth, puberty and removing the primary insult. In conditions where there is a little scope for bone recovery and limited residual growth, bone-targeted therapy may need to be considered, even though there is currently limited evidence. The importance of early detection of signs of bone fragility, by active screening for vertebral fracture using newer imaging techniques such as dual-energy X-ray absorptiometry lateral vertebral morphometry, may now be possible. There is currently, a paucity of evidence to support prophylactic use of anti-resorptive therapy. Where poor growth and low bone turnover are seen, the use of growth-promoting therapies and anabolic bone-protective agents may be more physiological and should be evaluated in well-designed trials. Collaborative studies on long-term fracture outcome and well-designed trials of bone-protective therapies are needed and to be encouraged.

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Pathological fractures in paediatric patients with inflammatory bowel disease

Cited by 33 publications

References 101 publications

Hospital costs, length of stay and prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease

Hospital costs, length of stay and prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease

Long-Term Vitamin D3 Supplementation Does Not Prevent Colonic Inflammation or Modulate Bone Health in IL-10 Knockout Mice at Young Adulthood

Skeletal Fragility in Children with Chronic Disease

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