Musculoskeletal health in newly diagnosed children with Crohn’s disease
- First Online:
We evaluated the impact of Crohn’s disease on muscle and bone strength, mass, density, and geometry in children with newly diagnosed CD and found profound muscle and bone deficits; nevertheless, the prevalence of vertebral fractures at this time point was low.
Crohn’s disease (CD) is an inflammatory condition of the gastrointestinal tract that can affect the musculoskeletal system. The objective of this study was to determine the prevalence of vertebral fractures and the impact of CD on muscle and bone mass, strength, density, and geometry in children with newly diagnosed CD.
Seventy-three children (26 girls) aged 7.0 to 17.7 years were examined within 35 days following CD diagnosis by lateral spine radiograph for vertebral fractures and by jumping mechanography for muscle strength. Bone and muscle mass, density, and geometry were assessed by dual-energy x-ray absorptiometry and peripheral quantitative computed tomography (pQCT).
Disease activity was moderate to severe in 66 (90%) patients. Mean height (Z-score −0.3, standard deviation (SD) 1.1, p = 0.02), weight (Z-score −0.8, SD 1.3, p < 0.01), body mass index (Z-score −1.0, SD 1.3, p < 0.01), lumbar spine areal bone mineral density (BMD; Z-score −1.1, SD 1.0, p < 0.01), total body bone mineral content (Z-score −1.5, SD 1.0, p < 0.01), and total body lean mass (Z-score −2.5, SD 1.1, p < 0.01) were all low for age and gender. pQCT showed reduced trabecular volumetric BMD at the tibial metaphysis, expansion of the bone marrow cavity and thin cortices at the diaphysis, and low calf muscle cross-sectional area. Jumping mechanography demonstrated low muscle power. Only one patient had a vertebral fracture.
Children with newly diagnosed CD have profound muscle and bone deficits; nevertheless, the prevalence of vertebral fractures at this time point was low.
KeywordsBone mineral density Children Crohn’s disease Muscle function
Body mass index
Bone mineral content
Bone mineral density
Bone mineral apparent density
Carboxyterminal C-terminal telopeptide of type I collagen
Pediatric Crohn’s Disease Activity Index
Peripheral quantitative computed tomography
- 12.Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL (2002) Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45–60CrossRefPubMedGoogle Scholar
- 18.Greulich WW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist. Stanford University Press, Stanford, CalifGoogle Scholar
- 20.Garn SM, Poznanski AK, Larson K (1976) Metacarpal lengths, cortical diameters and areas from the 10-state nutrition survey. In: Jaworski ZFG (ed) Proceedings of the first workshop on bone morphometry. University of Ottawa Press, Ottawa, pp 367–391Google Scholar
- 37.DeBoer MD, Thayu M, Griffin LM et al (2016) Increases in sex hormones during anti-tumor necrosis factor alpha therapy in adolescents with Crohn’s disease. J Pediatr 171(146–152):e141–e142Google Scholar
- 38.Augustine MV, Leonard MB, Thayu M, Baldassano RN, de Boer IH, Shults J, Denson LA, DeBoer MD, Herskovitz R, Denburg MR (2014) Changes in vitamin D-related mineral metabolism after induction with anti-tumor necrosis factor-alpha therapy in Crohn’s disease. J Clin Endocrinol Metab 99:E991–E998CrossRefPubMedPubMedCentralGoogle Scholar