Bone mineral density and nutritional status in children with chronic inflammatory bowel disease

Abstract

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. (Gut 1998;42:188-194)

Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

“…10 Children and adolescents with inflammatory bowel disease (IBD) have a higher prevalence of low BMD when compared with healthy peers. [11][12][13][14][15][16] Poor nutritional status, 15,16 delayed growth, 14,15 corticosteroid administration, 11,12,16 and the inflammatory process itself 12,17 have been reported as risk factors for this condition in children with IBD. The contribution of hypovitaminosis D to low BMD in children with IBD has not been systematically studied to date to our knowledge.…”

Bone density in a population-based cohort of premenopausal adult women with early onset inflammatory bowel disease

“…It is possible that the age of onset of IBD might be critical in determining the final peak BMD that is attained. Data suggest high rates of osteopenia among children with IBD (12)(13)(14). Furthermore, if a chronic inflammatory state (such as IBD), corticosteroid use, and malnutrition occur together during an important period of growth, then it is possible that ultimate adult bone size and mass will be stunted.…”

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“…The reduced muscular cross-section in CIBD was typically associated with a low thickness of cortical bone and a reduced trabecular bone density [20,69]. As many as 60 % of patients with Crohn's disease are sarcopaenic, 30-40 % of patients with Crohn's disease also develop osteopaenia, and 15 % show osteoporosis, thus doubling the risk of fractures [1,6,39]. In those with osteoporosis, the prevalence of vertebral fracture was 22 %, even in patients under the age of 30 years [35].…”