Osteoporosis in pediatric patients suffering from chronic inflammatory bowel disease with and without steroid treatment.
BACKGROUND
Children and adolescents suffering from inflammatory bowel disease (IBD) are at risk of developing osteoporosis as a result of treatment with corticosteroids as well as of nonsteroidal factors like inflammation and malnutrition. To study the impact of these factors on development of osteopathy, we compared the rate of osteoporosis in steroid-naive and steroid-treated pediatric IBD patients.


METHODS
In 90 patients (50 girls) with IBD (34 steroid-naive, 53 steroid-treated, 3 not known) aged 8.8 to 19.2 (14.4 +/- 2.2) years and 52 controls (27 girls) aged 6.1 to 17.6 (12.9 +/- 3.0) years, bone mineral density (BMD) of the lumbar spine was assessed with dual energy x-ray absorptiometry. Areal BMD values were transformed into volumetric densities called bone mineral apparent density (BMAD) and expressed as standard deviation scores (SDS) on the basis of the BMAD values of the controls.


RESULTS
The rate of osteoporotic patients (BMAD-SDS < -2) was 8% in girls and 20% in boys. There was a similar proportion of osteoporosis in steroid-naive (12%) and steroid-treated (11%) patients. SDS of body height showed a significant positive correlation with BMD-SDS but not with BMAD-SDS in almost all patient subgroups, indicating an interfering dependency of BMD from bone size.


CONCLUSIONS
The prevalence of osteoporosis in pediatric patients with IBD is approximately the same as in adult patients. Osteoporosis is already present before steroid treatment. Data of dual energy x-ray absorptiometry measurements should be transformed into volumetric parameters to compensate for short stature. Otherwise, a lot of growth-stunted patients may be falsely diagnosed as osteopenic.
Walther
Frank
F
University Children's Hospital, Faculty of Medicine, University of Rostock, Rembrandtstrasse 16/17, D-18057 Rostock. frank.walther@med.uni-rostock.de
Fusch
Christoph
C
Radke
Michael
M
Beckert
Sybille
S
Findeisen
Annette
A
D015502:Absorptiometry, Photon; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D001827:Body Height / Q000187:drug effects; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D003093:Colitis, Ulcerative / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D003424:Crohn Disease / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D012737:Sex Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood
D000305:Adrenal Cortex Hormones; D050071:Bone Density Conservation Agents; D014807:Vitamin D