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J Pediatr. 2014 Jun;164(6):1436-43.e1. doi: 10.1016/j.jpeds.2014.01.073. Epub 2014 Mar 17.

Compromised peak bone mass in patients with inflammatory bowel disease--a prospective study.

Author information

1
Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland. Electronic address: saila.laakso@helsinki.fi.
2
Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
3
Helsinki Medical Imaging Center, Department of Pediatric Radiology, Helsinki University Central Hospital, Helsinki, Finland.
4
Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Abstract

OBJECTIVE:

To evaluate peak bone mass attainment in children and adolescents with inflammatory bowel disease and to identify risk factors for suboptimal bone mass attainment.

STUDY DESIGN:

We conducted a prospective follow-up study of 47 children and adolescents (24 males) with ulcerative colitis (n = 30) or Crohn's disease (n = 17). They were assessed for lumbar spine areal bone mineral density (aBMD) and for height-adjusted whole body less head bone mineral content (BMC); the values were corrected for bone age.

RESULTS:

Altogether, 73% of the patients had completed pubertal development after the median follow-up time of over 5 years. Despite clinical inactivity of the disease in 70% of the patients at the follow-up visit, BMD or BMC Z-scores improved in none of the measurement sites. Lumbar spine aBMD Z-scores (mean difference [95% CI], -0.47 [-0.92 to -0.03]; P = .04) and whole body less head BMC height- and bone age-adjusted Z-scores (-0.52 [-1.01 to -0.02]; P = .04) decreased in patients who were pubertal at baseline and completed their pubertal development during the follow-up. Postpubertal patients had lower aBMD and BMC Z-scores in comparison with prepubertal and pubertal patients. Low lumbar spine aBMD (Z-score < -1.0) was associated with completed pubertal development, underweight, and greater lifetime cumulative weight-adjusted prednisolone dose. Vertebral fractures were detected in 3 patients (6%). One-fourth of the patients had insufficient serum 25-hydroxyvitamin D concentrations (<50 nmol/L).

CONCLUSIONS:

The longitudinal follow-up over the pubertal years shows that inflammatory bowel disease poses a significant threat for bone health. The suboptimal peak bone mass attainment may have life-long consequences.

PMID:
24650398
DOI:
10.1016/j.jpeds.2014.01.073
[Indexed for MEDLINE]

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