Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease

Sylvester, Francisco; Wyzga, Nancy; Hyams, Jeffrey S.; Davis, Patricia M.; Lerer, Trudy; Vance, Katherine; Hawker, Gillian; Griffiths, Anne M.

doi:10.1002/ibd.20006

Cited by 147 publications

(185 citation statements)

References 40 publications

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“…This was not the case, as serum IGF-I levels did not correlate with the markers of bone formation or resorption either before, during, or after the glucocorticoid treatment. Before therapy the IGF-I levels were low in children with active IBD, consistent with previous studies (25,27). During the glucocorticoid therapy serum IGF-I levels showed an upward trend completely opposite to other markers related to bone turnover and declined only after the cessation of the steroid.…”

Section: Discussionsupporting

confidence: 89%

“…This is supported by the negative correlation between ESR/faecal calprotectin and serum PINP levels in our study and the fact that steroid-naive IBD patients may present with osteoporosis (23,24). Additionally, in active disease other factors such as nutrition or physical inactivity leading to reduced loading of the bones may also contribute to the low PINP levels (25). During the glucocorticoid therapy serum PINP levels decreased further, and after treatment were significantly higher than at baseline.…”

Section: Discussionsupporting

confidence: 81%

“…In children the study protocols have not specifically addressed the change of IGF-I levels during steroid therapy (25,27). As IGF-I levels parallel the markers of bone metabolism in adults, however, we hypothesized that this could be seen also in paediatric IBD patients (17).…”

Section: Discussionmentioning

confidence: 99%

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Bone turnover and metabolism in paediatric patients with inflammatory bowel disease treated with systemic glucocorticoids

Vihinen

Kolho²,

Ashorn³

et al. 2008

European Journal of Endocrinology

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Objective: We investigated circulating markers of bone turnover before and during systemic glucocorticoid treatment in paediatric patients with inflammatory bowel disease (IBD). Methods: Twenty-two children (mean age, 12.3 years) with IBD necessitating peroral steroid therapy were studied, with special reference to bone formation and resorption markers amino-terminal type I collagen propeptide (PINP) and carboxyterminal telopeptide of type I collagen (ICTP) respectively. In addition, GH-related IGF-I and sex hormone-binding protein (SHBG) were measured. Bone markers were analyzed at the initiation of the glucocorticoid treatment, at 2 and 5 weeks thereafter and at 1 month following the withdrawal of the steroid. Control group comprised 22 IBD patients in remission.Results: PINP and IGF-I were already lower before glucocorticoid treatment serum in children with active IBD as compared with control children with IBD in remission (median PINP 271 vs 535 mg/l, P!0.05; IGF-I 23 vs 29 nmol/l, P!0.05). After 2 weeks of glucocorticoid treatment serum PINP levels had declined further, from 271 to 163 mg/l (P!0.001), serum ICTP from 14.2 to 9.6 mg/l (P!0.001), and SHBG from 54 to 35 nmol/l (P!0.001) respectively. By contrast, serum IGF-I increased from 23 to 37 nmol/l (P!0.001). One month after the withdrawal of the glucocorticoid, all bone markers restored to levels similar to the controls. Conclusions: Bone formation in children with active IBD appears compromised and systemic glucocorticoid treatment further suppresses bone turnover. After the cessation of the glucocorticoid the bone markers show immediate improvement.European Journal of Endocrinology 159 693-698

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 81%

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Bone turnover and metabolism in paediatric patients with inflammatory bowel disease treated with systemic glucocorticoids

Vihinen

Kolho²,

Ashorn³

et al. 2008

European Journal of Endocrinology

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“…In CD, there are several potential explanations for the etiology of poor bone health. These include the potential for chronic malabsorption of nutrients known to influence bone formation (vitamins D, K and calcium), decreased dietary intake because of the presence of significant GI symptoms (diarrhea, anorexia) or the presence of chronic inflammation, which is known to influence bone metabolism by depressing bone synthesis and upregulating bone resorption (Sylvester et al, 2007). Other factors known to influence overall bone health include reductions in endogenous synthesis in vitamin D because of poor sunlight exposure, particularly in those living in northern climates and changes in weightbearing activity (Roth et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Vitamin D and K status influences bone mineral density and bone accrual in children and adolescents with celiac disease

2011

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Background/Objectives: Children with celiac disease (CD) are at risk for decreased bone mineral density (BMD) because of fat-soluble vitamin malabsorption, inflammation and/or under-nutrition. The study objective was to determine the interrelationships between vitamin K/D status and lifestyle variables on BMD in children and adolescents with CD at diagnosis and after 1 year on the gluten-free diet (GFD). Subjects/Methods: Children and adolescents aged 3-17 years with biopsy proven CD at diagnosis and after 1 year on the GFD were studied. BMD was measured using dual-energy X-ray absorptiometry. Relevant variables included: anthropometrics, vitamin D/K status, diet, physical activity and sunlight exposure. Results: Whole-body and lumbar-spine BMD-z scores were low (pÀ1) at diagnosis (10-20%) and after 1 year (30-32%) in the children, independent of symptoms. Whole-body BMD-z scores (À0.55±0.7 versus 0.72±1.5) and serum levels of 25(OH) vitamin D (90.3 ± 24.8 versus 70.5 ± 19.8 nmol/l) were significantly lower in older children (410 years) when compared with younger children (p10 years) (Po0.001). Forty-three percent had suboptimal vitamin D status (25(OH)-vitamin D o75 nmol/l) at diagnosis; resolving in nearly half after 1 year on the GFD. Twenty-five percent had suboptimal vitamin K status at diagnosis; all resolved after 1 year. Conclusions: Children and adolescents with CD are at risk for suboptimal bone health at time of diagnosis and after 1 year on GFD; likely due in part to suboptimal vitamin D/K status. Therapeutic strategies aimed at optimizing vitamin K/D intake may contribute to improved BMD in children with CD.

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“…Тяжелую остеопению регистрируют у 3-6% детей с ЯК и у 12-18% пациентов с БК [14,[17][18][19]. Улучшению синтеза костной ткани способствуют соот-ветствующая возрасту нутритивная поддержка, упраж-нения с весовыми нагрузками, а также адекватный контроль заболевания с преодолением гормональной зависимости [14,16,18,20]. В детском возрасте ВЗК имеют ряд особенностей: 1) чаще регистрируются более распространенные формы БК и ЯК; 2) менее специфичная, стертая клиническая картина болезней; 3) влияние болезни на физическое половое развитие ребенка.…”

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Inflammatory Bowel Diseases in Children: Peculiarities of the Disease Course and Therapy

Gorelov¹,

Каннер²

2018

Med. sov.

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Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease

Abstract: Decreased bone turnover occurs in children newly diagnosed with IBD. Although indicators of osteoblast activity increase with clinical improvement, bone mineral accrual does not accelerate. Children with low BMI may be considered for BMD screening, since they are at risk for low bone mass.

Cited by 147 publications

References 40 publications

Bone turnover and metabolism in paediatric patients with inflammatory bowel disease treated with systemic glucocorticoids

Bone turnover and metabolism in paediatric patients with inflammatory bowel disease treated with systemic glucocorticoids

Vitamin D and K status influences bone mineral density and bone accrual in children and adolescents with celiac disease

Inflammatory Bowel Diseases in Children: Peculiarities of the Disease Course and Therapy

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