Impaired Bone Health in Inflammatory Bowel Disease: A Case–Control Study in 80 Pediatric Patients

Abstract

Previous studies have indicated that children with inflammatory bowel disease (IBD) may not achieve optimal bone mass. We evaluated the skeletal characteristics in children and adolescents with IBD. This cross-sectional cohort study comprised 80 IBD patients (median age 14.9 years, range 5-20) with a median disease duration of 3.4 years; 51 had ulcerative colitis, 26 Crohn disease, and 3 unspecified colitis. Eighty age- and gender-matched healthy subjects served as controls. Areal bone mineral density (aBMD), body composition, and vertebral fractures (VFs) were assessed by DXA. Bone age (BA) was determined for IBD patients. Findings were correlated with disease- and treatment-related parameters and biochemistry. IBD patients had lower BA-adjusted lumbar spine and whole-body aBMD (p < 0.001 for both) and whole-body BMC adjusted for height (p = 0.02) than controls. Lean mass and fat mass Z scores did not differ between the groups, but IBD patients had lower whole-body BMC relative to muscle mass (p = 0.006). Despite vitamin D supplementation in 48 %, vitamin D deficiency was common. In IBD cumulative weight-adjusted prednisolone dose >150 mg/kg for the preceding 3 years increased the risk for low whole-body aBMD (OR = 5.5, 95 % CI 1.3-23.3, p = 0.02). VFs were found in 11 % of patients and in 3 % of controls (p = 0.02). IBD in childhood was associated with low aBMD and reduced bone mass accrual relative to muscle mass; the risk for subclinical VFs may be increased. These observations warrant careful follow-up and active preventive measures.

Skeletal Fragility in Children with Chronic Disease

“…While the risk of long bone fractures may not be increased in children with IBD [55], a cross-sectional study in paediatric IBD showed that vertebral abnormalities from systematic spine X-ray/DXA screening were significantly higher (11%) than healthy controls (3%) [56]. Preliminary results suggest that the risk of fracture of childhood-onset IBD is also increased long-term in adulthood [57].…”

The Use of Bisphosphonates in Pediatrics

“…It frequently affects children with diffuse connective tissue diseases [21,22], inflammatory bowel diseases [23], chronic renal diseases [24,25], hematological malignancies [26,27,28,29], or solid tumors [30]. Systemic glucocorticoid treatment is associated with an initial increase in bone resorption and a subsequent reduction of bone formation, leading to decreased peak bone mass, microarchitectural deterioration and increased fracture risk [31,32,33,34].…”

Optimal vitamin D levels in Crohn's disease: a review

“…Low bone mineral density is a common manifestation in Crohn's disease (9,10) and guidelines regarding supplementation are well established (11) . Despite this vitamin D insufficiency remains common.…”