Musculoskeletal health in newly diagnosed children with Crohn’s disease
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
This study was supported by the Crohn’s and Colitis Foundation of America (Grant 1777). Dr. Ward was supported by a University of Ottawa Research Chair in Pediatric Bone Health, The Department of Pediatrics, Children’s Hospital of Eastern Ontario and the Department of Surgery, The Ottawa Hospital, Ottawa, Ontario. Dr. Ward was also supported by a CHEO Research Institute Capacity Building Award. Dr. Benchimol was supported by a New Investigator Award from the Canadian Institutes of Health Research, Canadian Association of Gastroenterology and Crohn’s and Colitis Canada. Dr. Benchimol was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. Pediatric reference ranges for peripheral quantitative computed tomography were provided by Babette Zemel, PhD and Mary Leonard, MD, MSCE, from the Reference Project on Bone Mineralization in Children, supported by the Research Institute and Nutrition Center of the Children’s Hospital of Philadelphia, and by the National Center for Research Resources (Grant Number UL1-RR-024134).
Compliance with ethical standards
Crohn’s and Colitis Foundation of America (Grant 1777), University of Ottawa Research Chair in Pediatric Bone Health, Children’s Hospital of Eastern Ontario Department of Surgery, and CHEO Research Institute. The study was approved by the CHEO Research Ethics Board.
Conflicts of interest
LMW has received consulting honoraria from and has been participating in trials with Novartis and Amgen. JM, FR, EIB, JH, MBL, MAM, NS, BL, HC, MS, VNK, and DRM have nothing to declare.
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