Osteopenia in Crohn's disease.

Abstract

(3-8 SD below the mean for normal young males) and the lumbar spine BMD was 0-3 g/cm2 . Even allowing for his weight and pubertal delay by comparing the lumbar spine BMD with that of a child with similar bone age it is 4-8 SD below the mean. A luteinising hormone/follicular stimulating hormone stimulation test showed a prepubertal response. Prednisolone treatment was reduced and stopped over the next three weeks. He was commenced on testosterone undecanoate 40 mg on alternative days and continued the elemental diet. Over the next 11 months his growth velocity improved to 9-9 cm/year and he progressed through puberty, achieving Tanner stage III. Repeat DEXA scan I1 months after diagnosis of osteopenia showed great improvement with a significant increase in bone mass and lumbar spine BMD had increased to 0-46 g/cm2, an increase of 74 5%, although the total BMD remained low at 0 743 g/cm2. Fourteen months after diagnosis he is asymptomatic, his haemoglobin, platelet count and albumin are normal, his weight has improved to 42-4 kg and he has achieved a height of 149-5 cm (-3-7 SD). DiscussionGrowth retardation and pubertal delay are well recognised complications of inflammatory bowel disease in childhood. The reported frequency of growth impairment in these children varies from 32 to 88%.3 In addition, an increased rate of cortical bone loss has been found in adults with inflammatory bowel disease.' Several inter-relating factors may have given rise to the osteopenia and growth retardation observed in our child. Malabsorption, protein energy deprivation secondary to a poor diet, and inadequate calcium intake will all result in a reduced rate of bone production.4 Furthermore, steroid treatment has a direct inhibitory effect on bone production and also results in an increased rate of bone loss by inducing hypercalciuria. In view of the early finding of osteopenia it may have been inappropriate to instigate high dose steroid treatment as 255 on 12 May 2018 by guest. Protected by copyright.

Bone mineral density in patients with inflammatory bowel disease: A population‐based prospective two‐year follow‐up study

“…Although the absolute risk of fracture is probably relatively low in the majority of IBD patients, a few suffer significant morbidity as a result of fractures, and vertebral compression fractures are reported even in young patients with CD (34)(35)(36). Identifying patients at highest risk continues to be difficult, but corticosteroid therapy and disease activity are likely to be important contributing factors.…”

Risk Factors for Low Bone Mineral Density in Children and Adolescents with Inflammatory Bowel Disease

“…The literature on this topic, though scant, already shows that there is a high incidence of bone loss in these patients, when compared to the normal population in the same age range [6][7][8], along with the occurrence of pathological fractures [9,10].…”

High prevalence of osteoporotic vertebral fractures in patients with Crohn's disease

“…The increased prevalence of osteopenia and osteoporosis is a significant complication in both children [1][2][3] and adults. [4][5][6][7][8][9][10][11][12] Bone loss rates have been shown to be increased in patients with IBD.…”