Longitudinal changes in bone mineral density in children with inflammatory bowel diseases

Abstract

Decreased bone mineral density (BMD) is an important extraintestinal complication of paediatric inflammatory bowel disease (IBD). 1 Almost 50% of children and adolescents with IBD have a BMD zscore of <−1 and about 25% have a BMD z-score <−2. 2 Children with IBD may have an increased risk for fractures during childhood, especially vertebral fractures. 3 Peak bone mass is reached by the third decade of life. Thus, children with IBD are at risk of failing to reach their optimal peak bone mass, and of having a higher incidence of fractures later, during adulthood. 4 A number of factors contribute to impaired BMD in IBD patients.These include: inflammatory cytokines, 5 glucocorticoid treatment, 6 malnutrition, 7 low calcium intake, vitamin D deficiency, 6 decreased Abbreviations: BMD, bone mineral density; DXA, dual-energy X-ray absorptiometry; IBD, inflammatory bowel disease; SDS, standard deviation score; TBLH, total body less head. Abstract Aim: Children with inflammatory bowel disease (IBD) are prone to low bone mineral density (BMD). Our aim was to assess longitudinal changes in BMD in this population. Methods: A retrospective longitudinal study of children with IBD, treated at two tertiary centres in Israel, who underwent two BMD measurements by dual-energy X-ray absorptiometry (DXA). Changes in lumbar spine BMD (∆L1-4 z-scores) were examined for correlations with clinical characteristics. Results: The cohort included 41 patients (age at diagnosis 12.1 ± 3.5 years, 23 females).The mean interval between the scans was 3.4 ± 2.0 years. There was a trend towards improvement in L1-4 z-scores (−1.64 ± 1.02 vs −1.45 ± 0.83, P = .12). ∆L1-4 z-scores correlated positively with ∆weight-standard deviation scores (SDS), ∆height-SDS and ∆BMI-SDS, and with age at the second scan (R = .55, P < .01; R = .42, P < .01; R = .42, P = .01; R = .35, P = .02, respectively); and negatively with L1-4 z-scores at the first scan (R = −.63, P < .01). Stepwise linear regression analysis identified the first scan L1-4 z-scores and ∆weight-SDS as independent predictors of ∆L1-4 z-scores. An L1-4 z-score ≤−2 at the first DXA scan was associated with significant improvement at the second scan.Conclusion: Improvement in BMD was more pronounced in children who gained weight or whose BMD was low at the first scan. K E Y W O R D S bone, bone mineral density, Crohn's disease, dual-energy X-ray absorptiometry, ulcerative colitis | 1027 LEVY-SHRAGA Et AL. activity, hypogonadism, decreased skeletal muscle mass 1 and possibly dysbiotic intestinal microbial flora. 8Only limited longitudinal data are available regarding changes in BMD in the course of IBD. Some studies in paediatric 9,10 and adult patients 11,12 found no significant changes in BMD z-scores during follow-up, despite clinical disease remission. However, others reported improvement with time. 13,14 The aim of our study was to examine longitudinal changes in BMD of children and adolescents with IBD, and associations of such changes with anthropometric parameters and disease activity.

Bone Mineral Density in Patients with Pediatric Inflammatory Bowel Disease Using Dual Energy X-Ray Absorptiometry

“…Our findings show no significant association between these 2 factors. This coincides with the findings of Levy-Shraga et al[ 22 ] and Lopes et al[ 23 ], in which there was no association between age at the time of diagnosis and a low BMD. This is in contrast to the findings of Saadah et al[ 13 ], Sohn et al[ 24 ], and Herzog et al[ 25 ], who reported that older age was strongly associated with lower BMD Z-scores in pediatric patients diagnosed with IBD.…”

Hypocalcemia and Vitamin D Deficiency in Children with Inflammatory Bowel Diseases and Lactose Intolerance

“…Patients with IBD are at increased risk of decreased bone mass. Poor nutritional status, delayed maturation, decreased physical activity, as well as chronic inflammation and malabsorption disorders are recognized as factors affecting bone growth and metabolism [ 2 , 27 , 29 ]. In the studied group of patients with CD, lower values of BMD Z-score were noted among patients with delayed growth (patients in the G1 group of the Paris classification).…”

“…The negative effect of glucocorticosteroids on bone mineral density is well documented [ 2 , 23 , 29 ]. In the studied group, no dependence on the use of glucocorticosteroids on the BMD Z-score was found, this may be due to the small study group (only 8 patients with densitometry were taking glucocorticoids before entering the study), and the cumulative dose of glucocorticosteroids was not calculated.…”

Management and monitoring of pediatric inflammatory bowel disease in the Asia‐Pacific region: A position paper by the Asian Pan‐Pacific Society for Pediatric Gastroenterology, Hepatology, and Nutrition (APPSPGHAN) PIBD Working Group: Surgical management, disease monitoring, and special considerations

“…PIBD poses a significant threat to bone health in children and adolescents, especially in children with prolonged exposure to CS or those who are undernourished 65 . Both decreased bone mineral density (BMD) and osteoporosis are recognized extraintestinal complications of PIBD 66 . Children with IBD may have an increased risk for fractures, especially vertebral fractures 67 …”