Interpretation of bone mineral density values in pediatric Crohn's disease

Herzog, Denise; Bishop, Nicholas; Glorieux, Francis H.; Seidman, Ernest G.

doi:10.1002/ibd.3780040402

Cited by 58 publications

(43 citation statements)

References 31 publications

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“…However, it needs to be applied with caution in children who may have growth delay, like children with IBD. 26,27 Smaller, adequately mineralized bones may appear less dense by DXA. In addition, the changing geometry and size of bone, the ratio of cortical to trabecular bone, and the thickness of soft tissues enveloping bone can also influence DXA.…”

Section: Discussionmentioning

confidence: 97%

Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease

Sylvester

Wyzga

Hyams

et al. 2007

Inflammatory Bowel Diseases

146

158

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Section: Discussionmentioning

confidence: 97%

Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease

Sylvester

Wyzga

Hyams

et al. 2007

Inflammatory Bowel Diseases

146

158

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“…The recruitment of girls took place in November and December, whereas the recruitment of boys took place in April and May. Two boys were excluded because of having Crohn's disease 25,26 and allergy to milk. 27,28 All participants were healthy, white, and free of any medications that may affect calcium metabolism.…”

Section: Participantsmentioning

confidence: 99%

Reduced Spinal Bone Mineral Density in Adolescents of an Ultra-Orthodox Jewish Community in Brooklyn

et al. 2001

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ABSTRACT. Objectives. Bone mass increases throughout childhood, with maximal bone mass accrual rate occurring in early to mid-puberty and slowing in late puberty. Prevention of osteoporosis and its morbidities depends primarily on the establishment of adequate peak bone mass. Physical activity, calcium intake, and vitamin D stores (from sunlight conversion of precursors of vitamin D and to a lesser degree from dietary intake) are vital determinants of bone mineral density (BMD). BMD is further controlled by genetic and environmental factors that are poorly understood.Observance of ultra-Orthodox Jewish customs may have a negative effect on the factors that promote bone health, and there have been anecdotal reports of higher fracture rates in this population. The ultra-Orthodox Jewish lifestyle encourages scholarly activity in preference to physical activity. Additionally, modest dress codes and inner-city dwelling reduce sunlight exposure. Orthodox Jews do not consume milk products for 6 hours after meat ingestion, leading to potentially fewer opportunities to consume calcium. Foods from the milk group are some of the best sources of dietary calcium.Our aims are to examine BMD in a group of healthy ultra-Orthodox Jewish adolescents in an urban community and to attempt to correlate it to physical activity and dietary factors.Design and Methods. We recruited 50 healthy, ultraOrthodox Jews, ages 15 to 19 years (30 males and 20 females). None were taking corticosteroids or had evidence of malabsorption. All girls were postmenarchal and nulliparous. Pubic hair Tanner stage for boys and breast Tanner stage for girls were determined. Weight and height standard deviation scores were calculated. Calcium, phosphorus, protein, vitamin D, and calorie intake were assessed using a comprehensive food questionnaire referring to what has been eaten over the last year. Hours per week of weight-bearing exercise and walking were determined. Lumbar spine (L) BMD was assessed by dual energy radiograph absorptiometry. The pediatric software supplied by Lunar Radiation Corporation, which contains gender-and age-specific norms, provided a z score for the lumbar BMD for each participant. L2 to L4 bone mineral apparent density (BMAD) was calculated from L2 to L4 BMD.Results. BMD of L2 to L4 was significantly decreased compared with age/sex-matched normative data: mean z score was ؊1.25 ؎ 1.25 (n ‫؍‬ 50). The mean L2 to L4 BMD z score ؎ standard deviation was ؊1.71 ؎ 1.18 for boys and ؊0.58 ؎ 1.04 for girls. Eight boys (27%) had L2 to L4 BMD z scores <؊2.5, which defines osteoporosis in adulthood. Twenty-seven adolescents (54%), 16 boys and 11 girls, had Tanner stage V. Two participants (4%) had delayed development of Tanner stage V. Mean consumption of calcium by participants under 19 years old was 908 ؎ 506 mg/day (n ‫؍‬ 46), which is lower than the adequate intake of 1300 mg/day for this age. The consumption of phosphorus was 1329 ؎ 606 mg/day, and the consumption of vitamin D was 286 ؎ 173 IU/day (n ‫؍‬ 50).The mean serum 25(OH)D level...

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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

186

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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Interpretation of bone mineral density values in pediatric Crohn's disease

Cited by 58 publications

References 31 publications

Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease

Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease

Reduced Spinal Bone Mineral Density in Adolescents of an Ultra-Orthodox Jewish Community in Brooklyn

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

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