Bone mineral density assessment in children with inflammatory bowel disease☆☆☆

Gokhale, Ranjana; Favus, Murray J.; Karrison, Theodore; Sutton, Marjorie M.; Rich, Barry H.; Kirschner, Barbara S.

doi:10.1016/s0016-5085(98)70309-9

Cited by 222 publications

(189 citation statements)

References 47 publications

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“…This prevalence of vitamin D deficiency is higher than has been reported previously, [18][19][20] higher than that among healthy New England adolescents (24.1% ≤15 ng/mL), 38 and similar in patients with CD and UC. Low serum albumin concentration was a significant independent predictor of low serum 25OHD concentration, a finding that has not been reported previously in patients with IBD, to our knowledge.…”

Section: Discussioncontrasting

confidence: 55%

“…The only pediatric study to examine vitamin D status of UC patients reports mean serum 25OHD concentrations similar and within normal limits in patients with CD and UC but without using a cutoff value to define vitamin D deficiency. 19 Our findings suggest that pediatric patients with CD and UC do not differ significantly in their vitamin D status and that, after adjusting for other factors, diagnosis becomes less significant. This may be of importance in clinical practice, because it suggests that certain risk factors predispose pediatric patients with IBD to low serum 25OHD concentrations regardless of diagnosis and that both patients with CD and UC may benefit from frequent monitoring of their vitamin D status.…”

Section: Discussionmentioning

confidence: 58%

“…Two of the 3 studies in pediatric subjects with IBD to report vitamin D status used a serum 25OHD concentration <15 ng/mL as the cutoff value for vitamin D deficiency and could have, as a result, underestimated the prevalence of this condition. 19,20 Naturally occurring seasonal variation in serum 25OHD concentrations may also lead to differences in reporting the prevalence of vitamin D deficiency among studies, depending on clustering of sampling during certain seasons. The sampling distribution across seasons was not reported in 2 studies, 19,20 but it was roughly uniform in our study.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…[18][19][20] Issenman et al 20 found normal 25OHD concentrations in children with Crohn disease (CD). Gokhale et al 19 reported lower 25OHD concentrations in children with CD than in those with ulcerative colitis (UC), but they were still within the reference range. Sentongo et al 18 found a 25OHD concentration ≤15 ng/mL in 16% of children with CD, lower concentration in patients with upper gastrointestinal tract (UGI) disease and greater lifetime corticosteroid exposure, and no relationship between 25OHD concentration and vitamin D intake.…”

Section: Introductionmentioning

confidence: 99%

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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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