Inflammatory bowel disease and predisposition to osteopenia

Cowan, Fiona; Warner, Justin; Dunstan, Frank David John; Evans, W. D.; Gregory, John Welbourn; Jenkins, Huw

doi:10.1136/adc.76.4.325

Cited by 105 publications

(77 citation statements)

References 33 publications

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“…Reduced bone mineral density (BMD) has been reported in more than 40% of adult patients with inflammatory bowel disease (IBD) in cross-sectional studies [1][2][3] and is more prevalent in CD than in ulcerative colitis (UC) [1,[4][5][6][7][8]. These findings also extend to children with IBD, with several studies demonstrating reduced bone mass in comparison to healthy children [4,7,[9][10][11][12].…”

Section: Introductionmentioning

confidence: 86%

Effect of exclusive enteral nutrition on bone turnover in children with Crohn’s disease

et al. 2009

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Section: Introductionmentioning

confidence: 86%

Effect of exclusive enteral nutrition on bone turnover in children with Crohn’s disease

et al. 2009

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Pappa¹,

Gordon

Saslowsky³

et al. 2006

Pediatrics

188

144

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OBJECTIVES-Previous studies of vitamin D status in pediatric patients with inflammatory bowel disease have revealed conflicting results. We sought to report (1) the prevalence of vitamin D deficiency (serum 25-hydroxy-vitamin D concentration ≤15 ng/mL) in a large population with inflammatory bowel disease, (2) factors predisposing to this problem, and (3) its relationship to bone health and serum parathyroid hormone concentration.PATIENTS AND METHODS-A total of 130 patients (8-22 years of age) with inflammatory bowel disease, 94 with Crohn disease and 36 with ulcerative colitis, had serum 25-hydroxyvitamin D, intact parathyroid hormone, and lumbar spine bone mineral density (using dual-energy x-ray absorptiometry) measured at Children's Hospital Boston. RESULTS-The prevalence of vitamin D deficiency was 34.6%. Mean serum 25-hydroxyvitamin D concentration was similar in patients with Crohn disease and ulcerative colitis, 52.6% lower among patients with dark skin complexion, 33.4% lower during the winter months (December 22 to March 21), and 31.5% higher among patients who were taking vitamin D supplements. Serum 25-hydroxy-vitamin D concentration was positively correlated with weight and BMI z score, disease duration, and serum albumin concentration and negatively correlated with erythrocyte sedimentation rate. Patients with Crohn disease and upper gastrointestinal tract involvement were more likely to be vitamin D deficient than those without it. Serum 25-hydroxyvitamin concentration was not associated with lumbar spine bone mineral density z score or serum parathyroid hormone concentration.CONCLUSIONS-Vitamin D deficiency is highly prevalent among pediatric patients with inflammatory bowel disease. Factors predisposing to the problem include having a dark-skin complexion, winter season, lack of vitamin D supplementation, early stage of disease, more severe disease, and upper gastrointestinal tract involvement in patients with Crohn disease. The long-term significance of hypovitaminosis D for this population is unknown at present and merits additional study. Copyright © 2006 by the American Academy of PediatricsAddress correspondence to Helen M. Pappa, MD, MPH, Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115. helen.pappa@childrens.harvard.edu. The authors have indicated they have no financial relationships relevant to this article to disclose. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2011 November 1. Available reports on the vitamin D status of adults with CD place the prevalence of 25OHD concentration ≤15 ng/mL between 22% and 70%, depending on the study. 21-31 Serum 25OHD concentration was found to be <10 ng/mL in 8% to 45% of adults with CD. 21,22,24,26 One study reports a negative relationship among disease duration, Crohn Disease Activity Index, ferritin, C-reactive protein, cholesterol, 24 and 25OHD concentration.Other studies report that smoking 21 and small bowel resection 30,32 are also negativel...

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“…Low bone mineral content has been described in children with short bowel syndrome during [17] and after weaning off PN [18,19]. Also, other chronic intestinal disorders, such as inflammatory bowel disease, have a negative effect on bone mineralization in children [20,21]. In addition to compromised bone mass accrual, progressively deteriorating axial growth, delayed pubertal maturation and reduced pubertal growth spurt are often noted in children suffering from chronic diseases [22,23].…”

Section: Introductionmentioning

confidence: 99%

Risk of Metabolic Bone Disease is Increased Both during and after Weaning off Parenteral Nutrition in Pediatric Intestinal Failure

Mutanen¹,

Mäkitie

Pakarinen³

2013

Horm Res Paediatr

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Aim: To assess bone health in pediatric intestinal failure (IF). Methods: A population-based cohort of 41 IF patients (age 9.9 years) underwent evaluation of bone mineral density (BMD), bone biochemistry, nutritional status and growth. Eleven patients remained on parenteral nutrition (PN) after 69 months. Thirty had weaned off PN 9.0 years earlier (mean), i.e. after 30 months on PN. Results: The majority of patients had lumbar spine or femoral BMD Z-score ≤-1.0 (70%), vitamin D deficiency (serum 25-hydroxyvitamin-D, S-25-OHD, <50 nmol/l, 41%) or secondary hyperparathyroidism (plasma parathyroid hormone >47 ng/l, 44%), equally during and after weaning off PN. Hyperparathyroidism was absent when S-25-OHD was >80 nmol/l. Until puberty, height (-1.4 to -0.8, age 1-12) and weight Z-scores (-1.3 to -0.5, age 1-16) were below the normal mean (p < 0.05). Small bowel length associated with S-25-OHD levels (r = 0.489, p = 0.013). In a multivariate model, time after weaning off PN (β = -0.597, p = 0.001), duration of PN (β = -0.466, p = 0.006) and calcium intake (β = -0.331, p = 0.035) predicted decreased lumbar spine BMD. Conclusions: In pediatric IF, vitamin D insufficiency, secondary hyperparathyroidism and decreased BMD are common. BMD, vitamin D, calcium and nutritional status should be closely monitored during and after weaning off PN to ensure sufficient vitamin D and mineral substitution for normal growth and bone mass attainment.

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Inflammatory bowel disease and predisposition to osteopenia

Cited by 105 publications

References 33 publications

Effect of exclusive enteral nutrition on bone turnover in children with Crohn’s disease

Effect of exclusive enteral nutrition on bone turnover in children with Crohn’s disease

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

Risk of Metabolic Bone Disease is Increased Both during and after Weaning off Parenteral Nutrition in Pediatric Intestinal Failure

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