Musculoskeletal system in children and adolescents with inflammatory bowel disease: normal muscle force, decreased trabecular bone mineral density and low prevalence of vertebral fractures

Maratová, Klara; Hradský, Ondřej; Matysková, Jana; Copova, Ivana; Souček, Ondřej; Šumnı́k, Zdenĕk; Bronský, Jiří

doi:10.1007/s00431-017-2988-7

Cited by 16 publications

(13 citation statements)

References 49 publications

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“…Inflammation itself can drive osteopenia through pro-inflammatory cytokines [33]. Impaired vitamin D status has been reported to be a risk factor for low bone mineral density (BMD) in IBD patients in some studies [34], but not in others [35], and single nucleotide polymorphism variants of the gene for the vitamin D receptor ( VDR ) have been shown to protect against low BMD in patients with IBD [36]. Supplementation with vitamin D and calcium has been shown to improve BMD in pediatric [37] and adult [38] IBD patients.…”

Section: Vitamin D Deficiency In Ibdmentioning

confidence: 99%

The Role of Vitamin D in Inflammatory Bowel Disease: Mechanism to Management

et al. 2019

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Vitamin D has been linked to human health benefits that extend far beyond its established actions on calcium homeostasis and bone metabolism. One of the most well studied facets of extra-skeletal vitamin D is its activity as an immuno-modulator, in particular its potent anti-inflammatory effects. As a consequence, vitamin D deficiency has been associated with inflammatory diseases including inflammatory bowel disease (IBD). Low serum levels of the major circulating form of vitamin D, 25-hydroxyvitamin D (25-OH-D) are significantly more prevalent in patients with IBD, particularly in the winter and spring months when UV-induced synthesis of vitamin D is lower. Dietary malabsorption of vitamin D may also contribute to low serum 25(OH)D in IBD. The benefits of supplementation with vitamin D for IBD patients are still unclear, and improved vitamin D status may help to prevent the onset of IBD as well as ameliorating disease severity. Beneficial effects of vitamin D in IBD are supported by pre-clinical studies, notably with mouse models, where the active form of vitamin D, 1,25-dihydroxyvitamin D (1,25-(OH)2D) has been shown to regulate gastrointestinal microbiota function, and promote anti-inflammatory, tolerogenic immune responses. The current narrative review aims to summarise the different strands of data linking vitamin D and IBD, whilst also outlining the possible beneficial effects of vitamin D supplementation in managing IBD in humans.

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Section: Vitamin D Deficiency In Ibdmentioning

confidence: 99%

The Role of Vitamin D in Inflammatory Bowel Disease: Mechanism to Management

et al. 2019

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Section: Discussionmentioning

confidence: 99%

“…Although limited guidelines have called for the incorporation of spine radiographs into the routine evaluation of a child at high risk for PVF, this has not yet become widespread practice. (1,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)18) The most common approach is to do spine radiographs only if a patient has either low BMD or back pain. (9)(10)(11)(12)(13) Our results show that either of these two approaches on their own will generate results similar to each other.…”

Section: Discussionmentioning

confidence: 99%

“…Because of concerns about cumulative radiation exposure in the pediatric population, however, it is not standard practice to perform spine radiographs in many of these conditions. Instead, radiographs are often only done when a patient develops new back pain or is found to have a very low bone mineral density (BMD) . VF are frequently asymptomatic, however, so relying on the presence of back pain will miss many fractures .…”

Section: Introductionmentioning

confidence: 99%

“…Instead, radiographs are often only done when a patient develops new back pain or is found to have a very low bone mineral density (BMD). (1,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) VF are frequently asymptomatic, however, so relying on the presence of back pain will miss many fractures. (14)(15)(16) Similarly, although reduced BMD is associated with fracture risk, the specific BMD threshold that should trigger radiography has not been defined.…”

Section: Introductionmentioning

confidence: 99%

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The Accuracy of Prevalent Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches

Siminoski

Wang

Alos

et al. 2019

Journal of Bone and Mineral Research

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Due to concerns about cumulative radiation exposure in the pediatric population, it is not standard practice to perform spine radiographs in most conditions that predispose to vertebral fracture (VF). In this study we examined the accuracy of two clinical predictors, back pain and lumbar spine bone mineral density (LS BMD), to derive four case‐finding paradigms for detection of prevalent VF (PVF). Subjects were 400 children at risk for PVF (leukemia 186, rheumatic disorders 135, nephrotic syndrome 79). Back pain was assessed by patient report, LS BMD was measured by dual‐energy X‐ray absorptiometry, and PVF were quantified on spine radiographs using the modified Genant semiquantitative method. Forty‐four patients (11.0%) had PVF. Logistic regression analysis between LS BMD and PVF produced an odds ratio (OR) of 1.9 (95% confidence interval [CI], 1.5 to 2.5) per reduction in Z‐score unit, an area under the receiver operating characteristic curve of 0.70 (95% CI, 0.60 to 0.79), and an optimal BMD Z‐score cutoff of −1.6. Case identification using either low BMD alone (Z‐score < −1.6) or back pain alone gave similar results for sensitivity (55%, 52%, respectively), specificity (78%, 81%, respectively), positive predictive value (PPV; 24%, 25%, respectively), and negative predictive value (NPV; 93%, 93%, respectively). The paradigm using low BMD plus back pain produced lower sensitivity (32%), higher specificity (96%), higher PPV (47%), and similar NPV (92%). The approach using low BMD or back pain had the highest sensitivity (75%), lowest specificity (64%), lowest PPV (20%), and highest NPV (95%). All paradigms had increased sensitivities for higher fracture grades. Our results show that BMD and back pain history can be used to identify children with the highest risk of PVF so that radiography can be used judiciously. The specific paradigm to be applied will depend on the expected PVF rate and the clinical approach to the use of radiography. © 2019 American Society for Bone and Mineral Research.

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

Gordon

2021

Curr Osteoporos Rep

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Musculoskeletal system in children and adolescents with inflammatory bowel disease: normal muscle force, decreased trabecular bone mineral density and low prevalence of vertebral fractures

Cited by 16 publications

References 49 publications

The Role of Vitamin D in Inflammatory Bowel Disease: Mechanism to Management

The Role of Vitamin D in Inflammatory Bowel Disease: Mechanism to Management

The Accuracy of Prevalent Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches

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

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