title: Pathological fractures in paediatric patients with inflammatory bowel disease.
abstract: Paediatric inflammatory bowel disease (IBD), especially Crohn's disease (CD), is commonly associated with poor skeletal health, related to the direct effects of chronic inflammation, prolonged use of glucocorticoid (GC), poor nutrition, delayed puberty and low muscle mass. Low bone mineral density is commonly reported, although the prevalence of long bone fractures may not be increased in these patients. Emerging evidence however suggests that there may be an increased risk of vertebral fractures (VFs) in this group. VFs presenting at diagnosis of paediatric CD, prior to any GC exposure, have been reported, highlighting the deleterious effect of inflammation on skeletal health. This paper reviews the published literature on pathophysiology of skeletal morbidity and fractures in paediatric IBD, illustrated with a new case report of multiple VFs in a prepubertal girl with CD, soon after diagnosis, who received minimal amounts of oral GC. Optimising control of disease, addressing vitamin D deficiency, encouraging physical activity and ensuring normal growth and pubertal progression are paramount to management of bone health in these patients. Despite the lack of evidence, there may be a place for bisphosphonate treatment, especially in the presence of symptomatic pathological fractures, but this requires close monitoring by clinicians with expertise in paediatric bone health.
  
  
  CONCLUSIONS
  Chronic inflammation mediated by pro-inflammatory cytokines may have adverse effects on skeletal health in paediatric patients with IBD. The risk of vertebral fractures may be increased, even without exposure to glucocorticoid. Clinical monitoring of these patients requires careful attention to the various factors that impact on bone health.
authors.affiliation: Department of Endocrinology, The Royal Children's Hospital, Flemington Road, Parkville, 3052, Melbourne, Australia, jarod.wong@rch.org.au.
authors.forename: Sze Choong
authors.initials: SC
authors.lastname: Wong
authors.forename: A G Anthony
authors.initials: AG
authors.lastname: Catto-Smith
authors.forename: Margaret
authors.initials: M
authors.lastname: Zacharin
mesh_terms: D000293:Adolescent; D001827:Body Height / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D004164:Diphosphonates / Q000627:therapeutic use; D005598:Fractures, Spontaneous / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008403:Mass Screening; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D011628:Puberty, Delayed / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D012307:Risk Factors; D016103:Spinal Fractures / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D004164:Diphosphonates; D011239:Prednisolone; D008775:Methylprednisolone