title: Bone turnover and metabolism in paediatric patients with inflammatory bowel disease treated with systemic glucocorticoids.
abstract: 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 microg/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 microg/l (P<0.001), serum ICTP from 14.2 to 9.6 microg/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.
authors.affiliation: Hospital for Children and Adolescents, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland. marianne.vihinen@helsinki.fi
authors.forename: Marianne K
authors.initials: MK
authors.lastname: Vihinen
authors.forename: Kaija-Leena
authors.initials: KL
authors.lastname: Kolho
authors.forename: Merja
authors.initials: M
authors.lastname: Ashorn
authors.forename: Matti
authors.initials: M
authors.lastname: Verkasalo
authors.forename: Taneli
authors.initials: T
authors.lastname: Raivio
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D016723:Bone Remodeling / Q000187:drug effects* / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood* / Q000188:drug therapy* / Q000378:metabolism; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D005938:Glucocorticoids; D007334:Insulin-Like Growth Factor I