Bone Health in Pediatric Patients with IBD: What Is New?

Gordon, R. G.; Gordon, Catherine M.

doi:10.1007/s11914-021-00691-x

Cited by 11 publications

(10 citation statements)

References 66 publications

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“…Nonetheless, the American Gastroenterological Association and the Endocrinology Associations all recommended regular use of 25-OH-vitamin D supplements (28). For this reason, patients would benefit from close follow-up for vitamin D supplementation and other precautions related to the protection of bone health (29). Unfortunately, most of patients' 25-OH-vitamin D levels were not screened.…”

Section: Discussionmentioning

confidence: 99%

İnflamatuvar bağırsak hastalığı olan çocuklarda osteoporoz sıklığının araştırılması

Taşkın¹

2023

Ümraniye Pediatri Dergisi - Journal of Umraniye Pediatrics

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Objective: Inflammatory bowel disease (IBD) is a rare condition in childhood. The aim of this study is to evaluate the presence of osteoporosis in patients diagnosed with IBD. Material and Methods:The study is retrospective design evaluating 34 patients aged 8-18 years with IBD who were followed up in the Pediatric Gastroenterology Outpatient Clinic in a tertiary hospital. Results: Of the 34 patients who were followed up, 17 (50%) had Crohn's disease and 17 (50%) had ulcerative colitis. The osteoporosis is detected in only one (2.9%) patient, four patients (11.7%) had low lumbar vertebra (L1-L4) bone mineral density (BMD) according to age, and two patients (5.8%) had low BMD according to height and sex-adjusted for Turkish children. When adjusted for United States children, 10 (29%) patients had low L1-L4 BMD. No relationship was found between the BMD Z-score and the age at diagnosis (r=-0.085, p=0.638), and the duration of disease (r=0.094, p=0.599). A moderate positive correlation was identified between the standardized body mass index and BMD Z-score of the patients (r=0.418, p=0.017). Conclusion:It was concluded that no relationship was found between the age at diagnosis, duration of disease, and BMD values in pediatric patients with IBD. The diagnosing of osteoporosis is difficult in children and confusing results was obtained when adjusted for population-based references. There is a need to ascertain normal standardized values for Turkish children to facilitate the standardized osteoporosis screening of patients.

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Section: Discussionmentioning

confidence: 99%

İnflamatuvar bağırsak hastalığı olan çocuklarda osteoporoz sıklığının araştırılması

Taşkın¹

2023

Ümraniye Pediatri Dergisi - Journal of Umraniye Pediatrics

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“…In patients with VEOIBD and concern for bone fragility, including both compression fractures and low BMD, there are frequently modifiable risk factors that can optimize bone health including: (1) goal 25‐hydroxy vitamin D level of between 30 and 50 ng/mL to maximize calcium absorption and ensure normal parathyroid hormone in this at‐risk population (32,33), with possibly higher 25‐hydroxy vitamin D levels in the 40–60 ng/mL range being beneficial for immune regulation and homeostasis. It is common within the setting of IBD to require higher doses of vitamin D to achieve and maintain vitamin D sufficiency (34); (2) achieving the recommended daily allowance for age of calcium, which is: 700 mg/d in 1–3 years old, 1000 mg/d in 4–8 years old, and 1300 mg/d in 9–18 years old (35). This goal is best achieved by dietary intake of calcium‐rich foods, but if unable to consume via the diet, calcium supplementation is an alternative; (3) ensuring normal range body mass index; (4) increasing weight‐bearing physical activity; (5) minimizing use of other medications known, or with potential, to adversely affect bone health (ie, glucocorticoids, PPIs, hormonal contraceptives); and (6) assessing for other comorbidities that may be adversely affecting bone health (ie, other hormonal factors, such as amenorrhea or thyroid disease) (34).…”

Section: Discussionmentioning

confidence: 99%

Vertebral Compression Fractures in Very Early Onset Inflammatory Bowel Disease

2023

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Objectives: To describe clinical characteristics and outcomes of 3 patients with very early onset inflammatory bowel disease (VEOIBD) and vertebral compression fractures. Methods: Patients with VEOIBD receiving care at a single tertiary center were prospectively enrolled in a longitudinal data repository. Retrospective chart review was performed to identify clinical characteristics and comorbidities. Those with clinically apparent vertebral compression fractures subsequently underwent an additional chart review focused on bone health. Results: Three out of 216 (1.4%) patients with VEOIBD had symptomatic vertebral compression fractures. Of the 3 patients with vertebral compression fractures, all had Crohn’s disease, 2 had monogenic inflammatory bowel disease, and all reported back pain. One patient notably had a normal dual-energy X-ray absorptiometry, highlighting a potential limitation of dual-energy X-ray absorptiometry to identify increased skeletal fragility in this population. Risk factors for suboptimal bone health included chronic inflammation secondary to poorly controlled inflammatory bowel disease, substantial glucocorticoid exposure, chronic use of other medications associated with suboptimal bone health including proton pump inhibitors and granulocyte colony-stimulating factor, and solid organ transplant. Patients treated with bisphosphonates had improved clinical outcomes, with resolution of back pain and increased bone mineral density. Conclusions: Vertebral compression fracture should be considered in the differential diagnosis of patients with VEOIBD and back pain, especially in those with other risk factors for suboptimal bone health. Treatment of compression fractures with bisphosphonates resulted in resolution of back pain and improved bone density.

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“…Patients with IBD are at increased risk for low bone mineral density and risk of fracture throughout their lifetime (44)(45)(46). There are likely multiple risk factors contributing to decreased bone accrual in children and adolescents with IBD, including vitamin D deficiency, chronic inflammation, malnutrition, poor gastrointestinal absorption, and exposure to glucocorticoids and other medications that may adversely affect bone, pubertal development, linear growth, and lean muscle mass accretion (24,(47)(48)(49). As a modifiable risk factor, successful treatment of vitamin D deficiency could pose long-term benefits by ensuring the presence of a sufficient ambient 25-OHD level to optimize skeletal health and thereby decrease bone fragility.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of High‐dose Cholecalciferol in Patients With Inflammatory Bowel Disease Receiving Infliximab

Gordon¹,

Wells²,

Johansen³

et al. 2022

J. pediatr. gastroenterol. nutr.

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Objective:Vitamin D deficiency is prevalent in patients with inflammatory bowel disease (IBD). The goal of this study was to assess the efficacy and safety of high-dose, interval cholecalciferol administration in patients with IBD receiving infliximab.Methods:This prospective, longitudinal, open-label study enrolled pediatric and young adult patients with IBD and vitamin D deficiency. Subjects received 50,000 IU every 4 to 5 weeks (n = 11) or 100,000 IU every 6 to 8 weeks (n = 32) of oral cholecalciferol for 1 year. Dosing was directly observed and administered in conjunction with infliximab infusions. The primary endpoint was vitamin D sufficiency, defined as a 25-hydroxy-vitamin D (25-OHD) level ≥30 ng/mL.Results:Forty-three participants constituted the primary analysis population. 25-OHD levels reached steady-state after the third dose, and mean increases in 25-OHD levels were 8 vs. 4.5 ng/mL in the 100,000 IU vs. 50,000 IU treatment groups, respectively. Only 43.8% of patients receiving 100,000 IU and 18.2% of patients receiving 50,000 IU achieved sufficiency. There was no difference in the 25-OHD level responsiveness in patients with Crohn disease versus those with ulcerative colitis (P = 0.72). There was no correlation between 25-OHD levels and clinical disease activity in patients with Crohn disease (P = 0.85) or ulcerative colitis (P = 0.24).Conclusions:Supplementation with cholecalciferol was well-tolerated and direct observation is a promising paradigm for ensuring compliance with therapy. Patients with IBD, however, appear to require high doses of cholecalciferol, with less than half of patients (37% overall) achieving vitamin D sufficiency. Additional studies are necessary to determine the optimal treatment regimens.

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Bone Health in Pediatric Patients with IBD: What Is New?

Cited by 11 publications

References 66 publications

İnflamatuvar bağırsak hastalığı olan çocuklarda osteoporoz sıklığının araştırılması

İnflamatuvar bağırsak hastalığı olan çocuklarda osteoporoz sıklığının araştırılması

Vertebral Compression Fractures in Very Early Onset Inflammatory Bowel Disease

Efficacy and Safety of High‐dose Cholecalciferol in Patients With Inflammatory Bowel Disease Receiving Infliximab

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