Impaired bone health in inflammatory bowel disease: a case-control study in 80 pediatric patients.
Previous studies have indicated that children with inflammatory bowel disease (IBD) may not achieve optimal bone mass. We evaluated the skeletal characteristics in children and adolescents with IBD. This cross-sectional cohort study comprised 80 IBD patients (median age 14.9 years, range 5-20) with a median disease duration of 3.4 years; 51 had ulcerative colitis, 26 Crohn disease, and 3 unspecified colitis. Eighty age- and gender-matched healthy subjects served as controls. Areal bone mineral density (aBMD), body composition, and vertebral fractures (VFs) were assessed by DXA. Bone age (BA) was determined for IBD patients. Findings were correlated with disease- and treatment-related parameters and biochemistry. IBD patients had lower BA-adjusted lumbar spine and whole-body aBMD (p < 0.001 for both) and whole-body BMC adjusted for height (p = 0.02) than controls. Lean mass and fat mass Z scores did not differ between the groups, but IBD patients had lower whole-body BMC relative to muscle mass (p = 0.006). Despite vitamin D supplementation in 48 %, vitamin D deficiency was common. In IBD cumulative weight-adjusted prednisolone dose >150 mg/kg for the preceding 3 years increased the risk for low whole-body aBMD (OR = 5.5, 95 % CI 1.3-23.3, p = 0.02). VFs were found in 11 % of patients and in 3 % of controls (p = 0.02). IBD in childhood was associated with low aBMD and reduced bone mass accrual relative to muscle mass; the risk for subclinical VFs may be increased. These observations warrant careful follow-up and active preventive measures.
Children's Hospital, Helsinki University Central Hospital and University of Helsinki, P.O. Box 281, 00029 Helsinki, Finland. saila.laakso@helsinki.fi
Saila
S
Laakso
Helena
H
Valta
Matti
M
Verkasalo
Sanna
S
Toiviainen-Salo
Heli
H
Viljakainen
Outi
O
Mäkitie
D000293:Adolescent; D001827:Body Height / Q000502:physiology; D015519:Bone Density; D001847:Bone Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D006304:Health Status; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D055815:Young Adult