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Iliac bone histomorphometry in children with newly diagnosed inflammatory bowel disease

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Abstract

Summary

Children with inflammatory bowel disease (IBD) manifest low bone mass; the cause remains unclear. We performed transilial bone biopsies in 20 IBD children at diagnosis and found a mild cortical bone deficit and slow bone turnover. It is possible that low mechanical stimulation due to inadequate muscle mass contributes to the bone deficit.

Introduction

Children with newly diagnosed IBD can have low bone mineral density and disturbed bone metabolism, but the tissue level characteristics of the bone involvement in pediatric IBD have not been elucidated.

Methods

In the present study, we evaluated the skeletal status, including static histomorphometry on transiliac bone samples, in 20 patients (age range 8.4 to 17.7 years, 12 boys) with newly diagnosed IBD and compared results to published normative data.

Results

Despite normal height (mean Z-score 0.04, SD 1.2), areal bone mineral density at the lumbar spine was moderately low (mean age- and sex-specific Z-score −0.8, SD 1.1). Total body bone mineral content and lean mass were low for age and sex as well (mean Z-scores −1.2, SD 0.9 and −2.0, SD 0.9, respectively). Biochemical bone markers indicated low bone formation and resorption activity. Bone histomorphometry revealed a slightly low cortical width (mean 23%, SD 25%, below the result expected for age) but a normal amount of trabecular bone. The percentage of trabecular bone surface covered by osteoid or osteoclasts was low, suggesting that both bone formation and bone resorption were suppressed.

Conclusions

Our results indicate that young patients manifest a mild cortical bone deficit at the iliac crest and slow trabecular bone turnover even at diagnosis, in the setting of IBD.

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Acknowledgements

The investigators would like to thank the following individuals at the Children’s Hospital of Eastern Ontario: Phuc-Nhi Phuong (patient recruitment and data entry), Maya Scharke (database management), Ruth Singleton (data collection and entry), Chantal Bergeron (patient care), and Josée Beauchamp (dietary assessments). We also thank Rose Travers, Guy Charette, and Mireille Dussault at the Shriners Hospital for Children in Montreal for technical assistance.

Funding

This study received funding from the Children’s Hospital of Eastern Ontario Research Institute, the Ottawa Snowflake Ball (in support of Crohn’s Disease, Colitis, and Colorectal Cancer) and the Shriners of North America (for histomorphometric analyses). Dr. Leanne Ward holds a Canadian Institutes for Health Research New Investigator Award and a Canadian Child Health Clinician Scientist Career Enhancement Award.

Conflicts of interest

None of the authors has a conflict of interest

Author information

Author notes

  1. L. M. Ward

    Present address: Director, Pediatric Bone Health Clinical and Research Programs, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada

Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada

    L. M. Ward, M. A. Matzinger, E. I. Benchimol, M. Boland & D. R. Mack

  2. Genetics Unit, Shriners Hospital for Children, McGill University, Montréal, Quebec, Canada

    L. M. Ward & F. Rauch

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  1. L. M. Ward
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Correspondence to L. M. Ward.

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Ward, L.M., Rauch, F., Matzinger, M.A. et al. Iliac bone histomorphometry in children with newly diagnosed inflammatory bowel disease. Osteoporos Int 21, 331–337 (2010). https://doi.org/10.1007/s00198-009-0969-z

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  • DOI: https://doi.org/10.1007/s00198-009-0969-z

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