Current Gastroenterology Reports

, Volume 5, Issue 3, pp 225–232 | Cite as

Perspectives on osteoporosis in pediatric inflammatory bowel disease

  • Manisha Harpavat
  • David J. Keljo


Osteoporosis is now recognized as a problem in children with chronic illness. Decreased bone mineral density and increased risk of fracture have been reported in children with inflammatory bowel disease (IBD). Recent studies have led to a better understanding of the pathogenesis of bone loss. There are many risk factors for osteopenia and osteoporosis in children with IBD. Dual-energy x-ray absorptiometry remains the diagnostic procedure of choice for assessment of bone mineral density, but other modalities are being explored. Guidelines for diagnosis and treatment of osteoporosis in children have not been established. This article reviews the current understanding of osteopenia and osteoporosis in children with IBD.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bailey DA, McKay HA, Mirwald RL, et al.: A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the University of Saskatchewan bone mineral accrual study. J Bone Miner Res 1999, 14:1672–1679.PubMedCrossRefGoogle Scholar
  2. 2.
    Matkovic V, Heaney RP: Calcium balance during human growth: evidence for threshold behavior. Am J Clin Nutr 1992, 55:992–996.PubMedGoogle Scholar
  3. 3.
    NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy: Osteoporosis prevention, diagnosis, and therapy. JAMA 2001, 285:785–795.CrossRefGoogle Scholar
  4. 4.
    Ray NF, Chan JK, Thamer M, Melton LJ: Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997, 12:24–35.PubMedCrossRefGoogle Scholar
  5. 5.
    Looker AC, Orwoll ES, Johnston CC Jr, et al.: Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 1997, 12:1761–1768.PubMedCrossRefGoogle Scholar
  6. 6.
    Bjarnason I, Macpherson A, Mackintosh C, et al.: Reduced bone density in patients with inflammatory bowel disease. Gut 1997, 40:228–233.PubMedGoogle Scholar
  7. 7.
    Andreassen H, Rungby J, Dahlerup JF, Mosekilde L: Inflammatory bowel disease and osteoporosis. Scand J Gastroenterol 1997, 32:1247–1255.PubMedGoogle Scholar
  8. 8.
    Ardizzone S, Bollani S, Bettica P, et al.: Altered bone metabolism in inflammatory bowel disease: There is a difference between Crohn’s disease and ulcerative colitis. J Intern Med 2000, 247:63–70. This cross-sectional study assessed bone metabolism in 91 IBD patients. Only 8% of patients with Crohn’s disease and 15% of patients with ulcerative colitis had normal BMD, 55% of Crohn’s disease and 67% of ulcerative colitis patients were osteopenic, and 37% of Crohn’s disease and 18% of ulcerative colitis patients were osteoporotic.PubMedCrossRefGoogle Scholar
  9. 9.
    Papaioannou A, Ferko NC, Adachi JD: All patients with inflammatory bowel disease should have bone density assessment: pro. Inflamm Bowel Dis 2001, 7:158–162. This article reviews the causes and prevalence of osteopenia and osteoporosis in adults with IBD. It advocates the use of BMD screening in these patients.PubMedCrossRefGoogle Scholar
  10. 10.
    Jahnsen J, Falch JA, Aadland E, Mowinckel P: Bone mineral density is reduced in patients with Crohn’s disease but not in patients with ulcerative colitis: a population based study. Gut 1997, 40:313–319.PubMedGoogle Scholar
  11. 11.
    Schoon EJ, van Nunen AB, Wouters RS, et al.: Osteopenia and osteoporosis in Crohn’s disease: prevalence in a Dutch population-based cohort. Scand J Gastroenterol 2000, 232(Suppl):43–47. This study reported a high prevelance of osteopenia and osteoporosis in patients with Crohn’s disease. Osteopenia was found in 45% and osteoporosis was found in 13% of all patients. Twenty-four percent of patients had a history of symptomatic fractures.Google Scholar
  12. 12.
    Haugeberg G, Vetvik K, Stallemo A, et al.: Bone density reduction in patients with Crohn disease and associations with demographic and disease variables: cross-sectional data from a population-based study. Scand J Gastroenterol 2001, 36:759–765. This study reported a 6% to 8% BMD reduction of the spine and hip in a cohort of patients with IBD. The use of prednisolone was found to be independently associated with BMD reduction.PubMedGoogle Scholar
  13. 13.
    Issenman RM, Atkinson SA, Rodja C, Fraher L: Longitudinal assessment of growth, mineral metabolism and bone mass in pediatric Crohn’s disease. J Pediatr Gastroentrol Nutr 1993, 17:401–406.CrossRefGoogle Scholar
  14. 14.
    Gokhale R, Favus M, Karrison T, et al.: Bone mineral density assessment in children with inflammatory bowel disease. Gastroenterology 1998, 114:902–911.PubMedCrossRefGoogle Scholar
  15. 15.
    Cowan FJ, Warner JT, Dunstan FJ, et al.: Inflammatory bowel disease and predisposition to osteopenia. Arch Dis Child 1997, 76:325–329.PubMedGoogle Scholar
  16. 16.
    Herzog D, Bishop N, Glorieux F, Seidman EG: Interpretation of bone mineral density values in pediatric Crohn’s disease. Inflamm Bowel Dis 1998, 4:261–267.PubMedCrossRefGoogle Scholar
  17. 17.
    Semeao EJ, Jawad AJ, Stallings VA, Piccoli DA: Effect of site of disease and steroid exposure on bone mineral density (BMD) in children with Crohn’s disease. J Pediatr Gastroenterol Nutr 1997, 25:A35.Google Scholar
  18. 18.
    Semeao EJ, Jawad AF, Stouffer NO, et al.: Risk factors for low bone mineral density in children and young adults with Crohn’s disease. J Pediatr 1999, 135:593–600.PubMedCrossRefGoogle Scholar
  19. 19.
    Cummings SR, Nevitt MC, Browner WS, et al.: Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995, 332:767–773.PubMedCrossRefGoogle Scholar
  20. 20.
    Cummings SR, Black DM, Nevitt MC, et al.: Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 1993, 341:72–75.PubMedCrossRefGoogle Scholar
  21. 21.
    Bernstein CN, Blanchard JF, Leslie W, et al.: The incidence of fracture among patients with inflammatory bowel disease: a population-based cohort study. Ann Intern Med 2000, 133:795–799. This large population-based study revealed a fracture rate among patients with IBD that was 40% higher than in the general population. Increased fracture incidence was reported in the spine, hip, wrist and forearm, and ribs.PubMedGoogle Scholar
  22. 22.
    Goulding A, Jones IE, Taylor RW, et al.: More broken bones: a 4-year double cohort study of young girls with and without distal forearm fractures. J Bone Miner Res 2000, 15:2011–2018.PubMedCrossRefGoogle Scholar
  23. 23.
    Pollitzer WS, Anderson JJ: Ethnic and genetic differences in bone mass: a review with a hereditary vs environmental perspective. Am J Clin Nutr 1989, 50:1244–1259.PubMedGoogle Scholar
  24. 24.
    Slemenda CW, Christian JC, Williams CJ, et al.: Genetic determinants of bone mass in adult women: a reevaluation of the twin model and the potential importance of gene interaction on heritability estimates. J Bone Miner Res 1991, 6:561–567.PubMedGoogle Scholar
  25. 25.
    Schonau E, Neu CM, Rauch F, et al.: The development of bone strength at the proximal radius during childhood and adolescence. J Clin Endocrinol Metab 2001, 86:613–618.CrossRefGoogle Scholar
  26. 26.
    Gilsanz V, Skaggs DL, Kovanlikaya A, et al.: Differential effect of race on the axial and appendicular skeletons of children. J Clin Endocrinol Metab 1998, 83:1420–1427.PubMedCrossRefGoogle Scholar
  27. 27.
    Favus MJ: Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, edn 4. Philadelphia: Lippincott, Williams & Wilkins; 1999.Google Scholar
  28. 28.
    Nieves JW, Golden AL, Siris E, et al.: Teenage and current calcium intake are related to bone mineral density of the hip and forearm in women aged 30–39 years. Am J Epidemiol 1995, 141:342–351.PubMedCrossRefGoogle Scholar
  29. 29.
    Johnston CC, Miller JZ, Slemenda CW, et al.: Calcium supplementation and increases in bone mineral density in children. N Engl J Med 1992, 327:82–87.PubMedCrossRefGoogle Scholar
  30. 30.
    Lee WT, Leung SS, Leung DM, et al.: Bone mineral acquisition in low calcium intake children following the withdrawal of calcium supplement. Acta Paediatr 1997, 86:570–576.PubMedGoogle Scholar
  31. 31.
    Slemenda CW, Reister TK, Peacock M, et al.: Bone growth in children following the cessation of calcium supplementation. J Bone Miner Res 1993, 8(Suppl_1):154.Google Scholar
  32. 32.
    Alaimo K, McDowell MA, Briefel RR: Dietary Intake of Vitamins, Minerals, and Fiber of Persons Ages 2 Months and Over in the United States: Third National Health and Nutrition Examination Survey, Phase I, 1988–91. Hyattsville, MD: National Center for Health Statistics, Department of Health and Human Services; 1994. Advance Data from Vital and Health Statistics, no 258.Google Scholar
  33. 33.
    Kristinsson JO, Valdimarsson O, Sigurdsson G, et al.: Serum 25-hydroxyvitamin D levels and bone mineral density in 16–20 year-old girls: lack of association. J Intern Med 1998, 243:381–388.PubMedCrossRefGoogle Scholar
  34. 34.
    Oliveri MB, Wittich A, Mautalen C, et al.: Peripheral bone mass is not affected by winter vitamin D deficiency in children and young adults from Ushuaia. Calcif Tissue Int 2000, 67:220–224.PubMedCrossRefGoogle Scholar
  35. 35.
    Fuchs RK, Bauer JJ, Snow CM: Jumping improves hip and lumbar spine bone mass in prepubescent children: a randomized controlled trial. J Bone Miner Res 2001, 16:148–156.PubMedCrossRefGoogle Scholar
  36. 36.
    McKay HA, Petit MA, Schutz RW, et al.: Augmented trochanteric bone mineral density after modified physical education classes: a randomized school-based exercise intervention study in prepubescent and early pubescent children. J Pediatr 2000, 136:156–162.PubMedCrossRefGoogle Scholar
  37. 37.
    Espallargues M, Sampietro-Colom L, Estrada MD, et al.: Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systematic review of the literature. Osteoporosis Int 2001, 12:811–822. This paper reviews the risk factors for fracture that are associated with the development of a low bone mass, describes and assesses the relationship between these factors and the risk of fracture, and classifies them according to the strength of their association with fracture incidence.CrossRefGoogle Scholar
  38. 38.
    Castro J, Zaro L, Pons F, et al.: Predictors of bone mineral density reduction in adolescents with anorexia nervosa. J Am Acad Child Adolesc Psychiatry 2000, 39:1365–1370.PubMedCrossRefGoogle Scholar
  39. 39.
    Theintz B, Buchs B, Rizzoli R, et al.: Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab 1992, 75:1060–1065.PubMedCrossRefGoogle Scholar
  40. 40.
    Matkovic V, Jelic T, Wardlaw GM, et al.: Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis: inference from a cross sectional model. J Clin Invest 1994, 93:799–808.PubMedGoogle Scholar
  41. 41.
    Rubin K, Schirduan V, Gendreau P, et al.: Predictors of axial and peripheral bone mineral density in healthy children and adolescents, with special attention to the role of puberty. J Pediatr 1993, 123:863–870.PubMedCrossRefGoogle Scholar
  42. 42.
    Azuma Y, Kaji K, Katogi R, et al.: Tumor necrosis factor-alpha induces differentiation of and bone resorption by osteoclasts. J Biol Chem 2000, 275:4858–4864.PubMedCrossRefGoogle Scholar
  43. 43.
    Kaji K, Katogi R, Azuma Y, et al.: Tumor necrosis factor alpha-induced osteoclastogenesis requires tumor necrosis factor receptor-associated factor 6. J Bone Miner Res 2001, 16:1593–1599.PubMedCrossRefGoogle Scholar
  44. 44.
    Gilbert L, He X, Farmer P, et al.: Inhibition of osteoblast differentiation by tumor necrosis factor-alpha. Endocrinology 2000, 141:3956–3964. Fetal rat calvaria preosteoblasts and a murine calvaria clonal osteoblastic cell line were used to study the effect of TNF-α on spontaneous differentiation of precursor cells toward the osteoblast phenotype. TNF-α was shown to inhibit in a dose-dependent fashion the differentiation of osteoblasts from their precursor cells.PubMedCrossRefGoogle Scholar
  45. 45.
    Gilbert L, He X, Farmer P, et al.: Expression of the osteoblast differentiation factor RUNX2 (Cbfa1/AML3/Pebp2alpha A) is inhibited by tumor necrosis factor-alpha. J Biol Chem 2002, 277:2695–2701.PubMedCrossRefGoogle Scholar
  46. 46.
    Nakagawa N, Kinosaki M, Yamaguchi K, et al.: RANK is the essential signaling receptor for osteoclast differentiation factor in osteoclastogenesis. Biochem Biophys Res Commun 1998, 253:395–400.PubMedCrossRefGoogle Scholar
  47. 47.
    Burgess TL, Qian Y, Kaufman S, et al.: The ligand for osteoprotegerin (OPGL) directly activates mature osteoclasts. J Cell Biol 1999, 145:527–538.PubMedCrossRefGoogle Scholar
  48. 48.
    Hsu H, Lacey DL, Dunstan CR, et al.: Tumor necrosis factor receptor family member RANK mediates osteoclast differentiation and activation induced by osteoprotegerin ligand. Proc Natl Acad Sci U S A 1999, 96:3540–3545.PubMedCrossRefGoogle Scholar
  49. 49.
    Li J, Sarosi I, Yan XQ, et al.: RANK is the intrinsic hematopoietic cell surface receptor that controls osteoclastogenesis and regulation of bone mass and calcium metabolism. Proc Natl Acad Sci U S A 2000, 97:1566–1571. In this study RANK nullizygous mice were used to determine the molecular genetic interactions between osteoprotegerin, osteoprotegerin ligand, and RANK during bone resorption and remodeling. The results indicate that RANK is the intrinsic cell-surface determinant that mediates osteoprotegerin ligand effects on bone resorption and remodeling as well as the physiologic and pathologic effects of calciotropic hormones and proresorptive cytokines.PubMedCrossRefGoogle Scholar
  50. 50.
    Kong YY, Yoshida H, Sarosi I, et al.: OPGL is a key regulator of osteoclastogenesis, lymphocyte development and lymphnode organogenesis. Nature 1999, 397:315–323.PubMedCrossRefGoogle Scholar
  51. 51.
    Simonet WS, Lacey DL, Dunstan CR, et al.: Osteoprotegerin: a novel secreted protein involved in the regulation of bone density. Cell 1997, 89:309–319.PubMedCrossRefGoogle Scholar
  52. 52.
    Tsuda E, Goto M, Mochizuki S, et al.: Isolation of a novel cytokine from human fibroblasts that specifically inhibits osteoclastogenesis. Biochem Biophys Res Commun 1997, 234:137–142.PubMedCrossRefGoogle Scholar
  53. 53.
    Bucay N, Sarosi I, Dunstan CR, et al.: Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification. Genes Dev 1998, 12:1260–1268.PubMedGoogle Scholar
  54. 54.
    Whyte MP, Obrecht SE, Finnegan PM, et al.: Osteoprotegerin deficiency and juvenile Paget’s disease. N Engl J Med 2002, 347:175–184. Two unrelated Navajo patients with juvenile Paget’s disease were evaluated for defects in the gene-encoding osteoprotegerin (TNFRSF11B) with polymerase chain reaction amplification followed by direct sequencing and Southern blotting of genomic DNA. Both patients had a homozygous deletion of TNFRSF11B, with identical break points on chromosome 8q24.2. Serum levels of osteoprotegerin and soluble osteoclast differentiation factor were found to be undetectable and markedly increased, respectively.PubMedCrossRefGoogle Scholar
  55. 55.
    Hofbauer LC, Khosla S, Dunstan CR, et al.: The roles of osteoprotegerin and osteoprotegerin ligand in the paracrine regulation of bone resorption. J Bone Miner Res 2000, 15:2–12.PubMedCrossRefGoogle Scholar
  56. 56.
    Kelly DG, Fleming CR: Nutritional considerations in inflammatory bowel diseases. Gastroenterol Clin North Am 1995, 24:597–611.PubMedGoogle Scholar
  57. 57.
    McCaffery TD, Nasr K, Lawrence AM, Kirsner JB: Severe growth retardation in children with inflammatory bowel disease. Pediatrics 1970, 45:386–393.PubMedGoogle Scholar
  58. 58.
    Griffiths AM, Nguyen P, Smith C, et al.: Growth and clinical course of children with Crohn’s disease. Gut 1993, 34:939–943.PubMedGoogle Scholar
  59. 59.
    Vogelsang H, Klamert M, Resch H, Ferenci P: Dietary vitamin D intake in patients with Crohn’s disease. Wiener Klinische Wochenschrift 1995, 107:578–581.PubMedGoogle Scholar
  60. 60.
    Silvennoinen J, Lamberg-Allardt C, Karkkainen M, et al.:Dietary calcium intake and its relation to bone mineral density in patients with inflammatory bowel disease. J Intern Med 1996, 240:285–292.PubMedCrossRefGoogle Scholar
  61. 61.
    Harries AD, Brown R, Heatley RV, et al.: Vitamin D status in Crohn’s disease: association with nutrition and disease activity. Gut 1985, 26:1197–1203.PubMedGoogle Scholar
  62. 62.
    Boot AM, Bouquet J, Krenning EP, et al.: Bone mineral density and nutritional status in children with chronic inflammatory bowel disease. Gut 1998, 42:188–194.PubMedCrossRefGoogle Scholar
  63. 63.
    Herbier LC, Gory F, Riggs BL, et al.: Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucocorticoids in human osteoblastic lineage cells: potential paracrine mechanisms of glucocorticoid-induced osteoporosis. Endocrinology 1999, 140:4382–4389.CrossRefGoogle Scholar
  64. 64.
    Reid IR, Gluckman PD, Ibbertson HK: Insulin-like growth factor 1 and bone turnover in glucocorticoid-treated and control subjects. Clin Endocrinol 1989, 30:347–353.Google Scholar
  65. 65.
    Lukert BP, Raisz LG: Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 1990, 112:352–364.PubMedGoogle Scholar
  66. 66.
    Silverman SL: Management of corticosteroid-induced osteoporosis: a clinician’s perspective. Calcif Tissue Int 1992, 50:101–103.PubMedCrossRefGoogle Scholar
  67. 67.
    Gennari C: Glucocorticoid induced osteoporosis. Clin Endocrinol 1994, 41:273–274.Google Scholar
  68. 68.
    LoCascio V, Bonucci E, Imbimbo B, et al.: Bone loss in response to long-term glucocorticoid therapy. Bone Miner 1990, 8:39–51.PubMedCrossRefGoogle Scholar
  69. 69.
    Ishida Y, Heersche JN: Glucocorticoid-induced osteoporosis: both in vivo and in vitro concentrations of glucocorticoids higher than physiological levels attenuate osteoblast differentiation. J Bone Miner Res 1998, 13:1822–1826.PubMedCrossRefGoogle Scholar
  70. 70.
    Thearle M, Horlick M, Bilezikian JP, et al.: Osteoporosis: an unusual presentation of childhood Crohn’s disease. J Clin Endocrinol Metab 2000, 85:2122–2126.PubMedCrossRefGoogle Scholar
  71. 71.
    Hyams JS, Wyzga N, Kreutzer DL, et al.: Alterations in bone metabolism in children with inflammatory bowel disease: an in vitro study. J Pediatr Gastroenterol Nutr 1997, 24:289–295.PubMedCrossRefGoogle Scholar
  72. 72.
    Pollak RD, Karmeli F, Eliakim R, et al.: Femoral neck osteopenia in patients with inflammatory bowel disease. Am J Gastroenterol 1998, 93:1483–1490.PubMedCrossRefGoogle Scholar
  73. 73.
    Nguyen L, Dewhirst FE, Hauschka PV, Stashenko P: Interleukin-1B stimulates bone resorption and inhibits bone formation in vivo. Lymphokine Cytokine Res 1991, 10:15–21.PubMedGoogle Scholar
  74. 74.
    Hughes FJ, Howells GL: Interleukin-6 inhibits bone formation in vitro. J Bone Miner Res 1993, 21:21–28.Google Scholar
  75. 75.
    Wallach S, Avioli LV, Feinblatt JD, Carstens JH Jr: Cytokines and bone metabolism. Calcif Tissue Int 1993, 53:293–296.PubMedCrossRefGoogle Scholar
  76. 76.
    Mahida YR, Wu K, Jewell DP: Enhanced production of interleukin-1B by mononuclear cells isolated from mucosa with active ulcerative colitis or Crohn’s disease. Gut 1989, 30:835–838.PubMedGoogle Scholar
  77. 77.
    Pullman WE, Elsbury S, Kobayashi M, et al.: Enhanced mucosal cytokine production in inflammatory bowel disease. Gastroenterology 1992, 102:529–537.PubMedGoogle Scholar
  78. 78.
    Southard RN, Morris JD, Mahan JD, et al.: Bone mass in healthy children: measurement with quantitative DXA. Radiology 1991, 179:735–738.PubMedGoogle Scholar
  79. 79.
    Bachrach LK: Dual energy X-ray absorptiometry (DEXA) measurements of bone density and body composition: promise and pitfalls. J Pediatr Endocrinol 2000, 13(Suppl_2):983–988. This article reviews the use of DEXA to assess BMD in children.Google Scholar
  80. 80.
    Gilsanz V: Bone density in children: a review of the available techniques and indications. Eur J Radiol 1998, 26:177–182.PubMedCrossRefGoogle Scholar
  81. 81.
    Mughal MZ, Ward K, Qayyum N, Langton CM: Assessment of bone status using the contact ultrasound bone analyzer. Arch Dis Child 1997, 76:535–536.PubMedCrossRefGoogle Scholar
  82. 82.
    Mughal MZ, Langton CM, Utretch G, et al.: Comparison between broad-band ultrasound attenuation of the calcaneum and total body bone mineral density in children. Acta Paediatr 1996, 85:663–665.PubMedGoogle Scholar
  83. 83.
    Frost ML, Blake GM, Fogelman I: Quantitative ultrasound and bone mineral density is equally strongly associated with risk factors for osteoporosis. J Bone Miner Res 2001, 16:406–416.PubMedCrossRefGoogle Scholar
  84. 84.
    Jahnsen J, Falch JA, Mowinckel P, Aadland E: Ultrasound measurements of calcaneus for estimation of skeletal status in patients with inflammatory bowel disease. Scand J Gastroenterol 1999, 34:790–797.PubMedCrossRefGoogle Scholar
  85. 85.
    Levine A, Mishna L, Ballin A, et al.: Use of quantitative ultrasound to assess osteopenia in children with Crohn disease. J Pediatr Gastroenterol Nutr 2002, 35:169–172. In this study quantitative ultrasound was used to measure the BMD of the left radius and tibia in children with Crohn’s disease. Significantly fewer cases of osteopenia were detected using quantitative ultrasound compared with DEXA.PubMedCrossRefGoogle Scholar
  86. 86.
    Greenspan SL, Rosen HN, Parker RA: Early changes in serum N-telopeptide and C-telopeptide cross-linked collagen type 1 predict long-term response to alendronate therapy in elderly women. J Clin Endocrinol Metab 2000, 85:3537–3540.PubMedCrossRefGoogle Scholar
  87. 87.
    Dresner-Pollak R, Karmeli F, Eliakim R, et al.: Increased urinary N-telopeptide cross-linked type 1 collagen predicts bone loss in patients with inflammatory bowel disease. Am J Gastroenterol 2000, 95:699–704. In this study, a cohort of IBD patients were followed over 2 years. More than one third of the patients experienced spine and femoral neck bone loss. Urinary N-telopeptide cross-linked type I collagen levels were inversely correlated with the rate of change in BMD of the spine.PubMedCrossRefGoogle Scholar
  88. 88.
    Nielsen HK, Charles P, Mosekilde L: The effect of single oral doses of prednisone on the circadian rhythm of serum osteocalcin in normal subjects. J Clin Endocrinol Metabol 1988, 67:1025–1030.CrossRefGoogle Scholar
  89. 89.
    Bernstein CN, Seeger LL, Anton PA, et al.: A randomized, placebo-controlled trial of calcium supplementation for decreased bone density in corticosteroid-using patients with inflammatory bowel disease: a pilot study. Aliment Pharmacol Ther 1996, 10:777–786.PubMedCrossRefGoogle Scholar
  90. 90.
    Clements D, Compston JE, Evans WD, Rhodes J: Hormone replacement therapy prevents bone loss in patients with inflammatory bowel disease. Gut 1993, 34:1543–1546.PubMedGoogle Scholar
  91. 91.
    Plotkin LI, Weinstein RS, Parfitt AM, et al.: Prevention of osteocyte and osteoblast apoptosis by bisphosphonates and calcitonin. J Clin Invest 1999, 104:1363–1374.PubMedCrossRefGoogle Scholar
  92. 92.
    Black DM, Cummings SR, Karpf DB, et al.: Randomized trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996, 348:1535–1541.PubMedCrossRefGoogle Scholar
  93. 93.
    Haderslev KV, Tjellesen L, Sorensen HA, Staun M: Alendronate increases lumbar spine bone mineral density in patients with Crohn’s disease. Gastroenterology 2000, 119:639–646. This 12-month double-blind, randomized, placebo-controlled trial, examined the effect of a 10-mg daily dose of alendronate on the BMD of patients with Crohn’s disease. Treatment with alendronate significantly increased BMD in patients with Crohn’s disease and appeared to be safe and tolerated well.PubMedCrossRefGoogle Scholar
  94. 94.
    Morony S, Capparelli C, Lee R, et al.: A chimeric form of osteoprotegerin inhibits hypercalcemia and bone resorption induced by IL-1beta, TNF-alpha, PTH, PTHrP, and 1, 25(OH)2D3. J Bone Miner Res 1999, 14:1478–1485.PubMedCrossRefGoogle Scholar
  95. 95.
    Bekker PJ, Holloway D, Nakanishi A, et al.: The effect of a single dose of osteoprotegerin in postmenopausal women. J Bone Miner Res 2001, 16:348–360. This randomized, double-blind, placebo-controlled, sequential doseescalation study was conducted in postmenopausal women to determine the effect of a single subcutaneous dose of osteoprotegerin on bone resorption. Urinary N-telopeptide levels decreased and bonespecific alkaline phosphatase levels did not change, suggesting that osteoprotegerin rapidly and profoundly reduced bone turnover for a sustained period of time.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Manisha Harpavat
    • 1
  • David J. Keljo
    • 1
  1. 1.University of Pittsburgh School of MedicineChildren’s Hospital of PittsburghPittsburghUSA

Personalised recommendations