Bone Mineral Density in Patients with Pediatric Inflammatory Bowel Disease Using Dual Energy X-Ray Absorptiometry
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Background: Inflammatory bowel disease (IBD) is a chronic inflammatory immune-mediated condition that affects the gastrointestinal system and alters bone growth and bone mineral density (BMD). Here we aimed to study the prevalence and predictors of a low BMD in pediatric patients with IBD. Methods: This retrospective cross-sectional analytical study included pediatric patients with IBD in whom BMD was evaluated using dual energy X-ray absorptiometry of the total body and lumbar spine. Osteoporosis was defined as a BMD Z-score ≤-2, osteopenia as -2 to -1, and normal as >-1. Clinical and laboratory findings were compared between patients with and without osteoporosis. Results: Of the 48 patients, 30 (62.5%) were males, 35 (72.9%) had Crohn’s disease, and 13 (27.1%) had ulcerative colitis. The mean age at diagnosis was 9.9±2.8 years. The median age at the time of the BMD scans was 11.9 (interquartile range, 9.9–14.3) years. Total body BMD scans identified 13 (27.1%) and 16 (33.3%) patients with osteoporosis and osteopenia, respectively. Spinal BMD scans revealed that 17 (39.5%) and 14 (32.6%) patients had osteoporosis and osteopenia, respectively. A low body mass index (BMI) Z-score (P=0.038), ileocolonic disease location (P=0.008), and a low calcium level (P=0.008) were significant predictors of osteoporosis on the total body BMD scans. A low BMI Z-score (P=0.039), decreased hemoglobin level (P=0.018), low calcium level (P=0.033), and infliximab use (P=0.019) were significant predictors of osteoporosis on the spinal BMD scans. Conclusions: This study showed a high prevalence of low BMD among pediatric patients with IBD. A low BMI, ileocolonic disease location, low hemoglobin and calcium levels, and infliximab use were significantly associated with osteoporosis.
Abstract
Background: Inflammatory bowel disease (IBD) is a chronic inflammatory immune-mediated condition that affects the gastrointestinal system and alters bone growth and bone mineral density (BMD). Here we aimed to study the prevalence and predictors of a low BMD in pediatric patients with IBD. Methods: This retrospective cross-sectional analytical study included pediatric patients with IBD in whom BMD was evaluated using dual energy X-ray absorptiometry of the total body and lumbar spine. Osteoporosis was defined as a BMD Z-score ≤-2, osteopenia as -2 to -1, and normal as >-1. Clinical and laboratory findings were compared between patients with and without osteoporosis. Results: Of the 48 patients, 30 (62.5%) were males, 35 (72.9%) had Crohn’s disease, and 13 (27.1%) had ulcerative colitis. The mean age at diagnosis was 9.9±2.8 years. The median age at the time of the BMD scans was 11.9 (interquartile range, 9.9–14.3) years. Total body BMD scans identified 13 (27.1%) and 16 (33.3%) patients with osteoporosis and osteopenia, respectively. Spinal BMD scans revealed that 17 (39.5%) and 14 (32.6%) patients had osteoporosis and osteopenia, respectively. A low body mass index (BMI) Z-score (P=0.038), ileocolonic disease location (P=0.008), and a low calcium level (P=0.008) were significant predictors of osteoporosis on the total body BMD scans. A low BMI Z-score (P=0.039), decreased hemoglobin level (P=0.018), low calcium level (P=0.033), and infliximab use (P=0.019) were significant predictors of osteoporosis on the spinal BMD scans. Conclusions: This study showed a high prevalence of low BMD among pediatric patients with IBD. A low BMI, ileocolonic disease location, low hemoglobin and calcium levels, and infliximab use were significantly associated with osteoporosis.
참고문헌 (34)
- Isa HM, "Pediatric Crohn’s disease in Bahrain", Oman Med J, 33, pp.299~308 (2018)[DOI]
- Xia B, "Inflammatory bowel disease: definition, epidemiology, etiologic aspects, and immunogenetic studies", World J Gastroenterol, 4, pp.446~458 (1998)[DOI]
- Ferreira SD, "Extraintestinal manifestations of inflammatory bowel disease : Clinical aspects and pathogenesis", J Gastroenterol Dig Dis, 3, pp.4~11 (2018)
- Levine JS, "Extraintestinal manifestations of inflammatory bowel disease", Gastroenterol Hepatol(N Y), 7, pp.235~241 (2011)
- 오현진, "Osteoporosis and Osteoporotic Fractures in Gastrointestinal Disease", 대한골대사학회지, 25(4), pp.213~217 (2018), 대한골대사학회
- Guz-Mark A, "Pediatric-onset inflammatory bowel disease poses risk for low bone mineral density at early adulthood", Dig Liver Dis, 49, pp.639~642 (2017)[DOI]
- Schmidt S, "Low bone mineral density in children and adolescents with inflammatory bowel disease : a population-based study from Western Sweden", Inflamm Bowel Dis, 15, pp.1844~1850 (2009)[DOI]
- Katz S, "Osteoporosis and gastrointestinal disease", Gastroenterol Hepatol(N Y), 6, pp.506~517 (2010)
- Delmas PD, "Bone mass measurement: how, where, when and why?", Int J Fertil Menopausal Stud, 38(Suppl 2), pp.70~76 (1993)
- IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, "Inflammatory bowel disease in children and adolescents: Recommendations for diagnosis-the Porto criteria", J Pediatr Gastroenterol Nutr, 41, pp.1~7 (2005)[DOI]
- Bousvaros A, "Differentiating ulcerative colitis from Crohn disease in children and young adults: report of a working group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Crohn's and Colitis Foundation of America", J Pediatr Gastroenterol Nutr, 44, pp.653~674 (2007)[DOI]
- Levine A, "Pediatric modification of the montreal classification for inflammatory bowel disease : The Paris classification", Inflamm Bowel Dis, 17, pp.1314~1321 (2011)[DOI]
- Saadah OI, "Prevalence and predictors of reduced bone density in child and adolescent patients with Crohn’s disease", J Clin Densitom, 24, pp.252~258 (2021)[DOI]
- Bishop N, "Fracture prediction and the definition of osteoporosis in children and adolescents : the ISCD 2013 Pediatric Official Positions", J Clin Densitom, 17, pp.275~280 (2014)[DOI]
- Sadat-Ali M, "Osteoporosis among Bahraini citizens : The first report", Int J Appl Basic Med Res, 10, pp.164~166 (2020)[DOI]
- AlSayyad AS, "Prevalence and risk factors of osteoporosis in Bahrain : A cross-sectional study among young female attending primary care centers", J Bahrain Med Soc, 33, pp.22~28 (2021)[DOI]
- Sylvester FA, "Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease", Inflamm Bowel Dis, 13, pp.42~50 (2007)[DOI]
- Nobile S, "Risk factors for low bone mineral density in pediatric inflammatory bowel disease : the positive role of physical activity", Eur J Gastroenterol Hepatol, 30, pp.471~476 (2018)[DOI]
- Vanhelst J, "Physical activity is associated with improved bone health in children with inflammatory bowel disease", Clin Nutr, 39, pp.1793~1798 (2020)[DOI]
- Setty-Shah N, "Adiposity is associated with early reduction in bone mass in pediatric inflammatory bowel disease", Nutrition, 32, pp.761~766 (2016)[DOI]
- Wada Y, "Risk factors for decreased bone mineral density in inflammatory bowel disease : A cross-sectional study", Clin Nutr, 34, pp.1202~1209 (2015)[DOI]
- Levy-Shraga Y, "Longitudinal changes in bone mineral density in children with inflammatory bowel diseases", Acta Paediatr, 109, pp.1026~1032 (2020)[DOI]
- Lopes LH, "Risk factors for low bone mineral density in children and adolescents with inflammatory bowel disease", Dig Dis Sci, 53, pp.2746~2753 (2008)[DOI]
- Jenny Sohn, "Vitamin D Status and Bone Mineral Density in Children with Inflammatory Bowel Disease Compared to Those with Functional Abdominal Pain", Journal of Korean Medical Science, 32(6), pp.961~967 (2017), 대한의학회
- Herzog D, "Interpretation of bone mineral density values in pediatric Crohn's disease", Inflamm Bowel Dis, 4, pp.261~267 (1998)[DOI]
- Pappa HM, "Report on the vitamin D status of adult and pediatric patients with inflammatory bowel disease and its significance for bone health and disease", Inflamm Bowel Dis, 12, pp.1162~1174 (2006)[DOI]
- Khan ZAW, "Prevalence of low bone mineral density in inflammatory bowel disease and factors associated with it", Indian J Gastroenterol, 39, pp.346~353 (2020)[DOI]
- Maratova K, "Musculoskeletal system in children and adolescents with inflammatory bowel disease: normal muscle force, decreased trabecular bone mineral density and low prevalence of vertebral fractures", Eur J Pediatr, 176, pp.1355~1363 (2017)[DOI]
- El-Matary W, "Bone mineral density, vitamin D, and disease activity in children newly diagnosed with inflammatory bowel disease", Dig Dis Sci, 56, pp.825~829 (2011)[DOI]
- Owczarek D, "Diet and nutritional factors in inflammatory bowel diseases", World J Gastroenterol, 22, pp.895~905 (2016)[DOI]
- Schmidt S, "Longitudinal assessment of bone mineral density in children and adolescents with inflammatory bowel disease", J Pediatr Gastroenterol Nutr, 55, pp.511~518 (2012)[DOI]
- Ghishan FK, "Vitamins and minerals in inflammatory bowel disease", Gastroenterol Clin North Am, 46, pp.797~808 (2017)[DOI]
- Abreu MT, "Treatment with infliximab is associated with increased markers of bone formation in patients with Crohn's disease", J Clin Gastroenterol, 40, pp.55~63 (2006)[DOI]
- Cushing K, "Management of Crohn disease : A review", JAMA, 325, pp.69~80 (2021)[DOI]