title: Bone mineral density assessment in children with inflammatory bowel disease.
abstract: OBJECTIVE
  Children with inflammatory bowel disease (IBD) are at risk for osteoporosis because of undernutrition, delayed puberty, and prolonged corticosteroid use. The aim of this study was to compare bone mineral density (BMD) in children with IBD with that in normal children and to assess the effects of nutritional and hormonal factors and corticosteroid dosages on BMD.
  
  
  METHODS
  One hundred sixty-two subjects (99 with IBD and 63 healthy sibling controls) were enrolled. Patients underwent anthropometric assessment, pubertal staging, bone age radiography, and BMD assessment by dual energy x-ray absorptiometry of the lumbar spine, femoral neck, and radius. Laboratory evaluations included serum calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, parathyroid hormone, osteocalcin, urinary N-telopeptides, albumin, insulin-like growth factor I, and testosterone or estradiol. Cumulative corticosteroid doses were calculated.
  
  
  RESULTS
  BMD Z scores at the lumbar spine and femoral neck were lower in patients with IBD, and lower in those with Crohn's disease compared with those with ulcerative colitis. Low BMD persisted after correction for bone age in girls with Crohn's disease (lumbar spine, P = 0.004; femoral neck, P = 0.002). Cumulative corticosteroid dose was a significant predictor of reduced BMD. BMD did not correlate with measures of calcium homeostasis, except elevated serum phosphate and urine calcium levels in girls.
  
  
  CONCLUSIONS
  Low BMD occurs in children with IBD (more in Crohn's disease than in ulcerative colitis), especially pubertal and postpubertal girls. Cumulative corticosteroid dose is a predictor of low BMD, but other factors in Crohn's disease remain undetermined.
authors.affiliation: Section of Pediatric Gastroenterology, University of Chicago, Chicago, Illinois 60614, USA.
authors.forename: R
authors.initials: R
authors.lastname: Gokhale
authors.forename: M J
authors.initials: MJ
authors.lastname: Favus
authors.forename: T
authors.initials: T
authors.lastname: Karrison
authors.forename: M M
authors.initials: MM
authors.lastname: Sutton
authors.forename: B
authors.initials: B
authors.lastname: Rich
authors.forename: B S
authors.initials: BS
authors.lastname: Kirschner
mesh_terms: D000293:Adolescent; D015519:Bone Density; D002118:Calcium / Q000378:metabolism; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000378:metabolism*; D008297:Male; D009752:Nutritional Status; D011446:Prospective Studies; D011627:Puberty; D011884:Radius / Q000378:metabolism; D012016:Reference Values
chemical_list: D006728:Hormones; D002118:Calcium