Musculoskeletal health in newly diagnosed children with Crohn’s disease

  • L. M. Ward
  • J. Ma
  • F. Rauch
  • E. I. Benchimol
  • J. Hay
  • M. B. Leonard
  • M. A. Matzinger
  • N. Shenouda
  • B. Lentle
  • H. Cosgrove
  • M. Scharke
  • V. N. Konji
  • D. R. Mack
Original Article

Abstract

Summary

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.

Introduction

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.

Methods

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).

Results

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.

Conclusions

Children with newly diagnosed CD have profound muscle and bone deficits; nevertheless, the prevalence of vertebral fractures at this time point was low.

Keywords

Bone mineral density Children Crohn’s disease Muscle function 

Abbreviations

BMI

Body mass index

BMC

Bone mineral content

BMD

Bone mineral density

BMAD

Bone mineral apparent density

CTX

Carboxyterminal C-terminal telopeptide of type I collagen

CI

Confidence interval

CD

Crohn’s disease

IQR

Interquartile range

PCDAI

Pediatric Crohn’s Disease Activity Index

pQCT

Peripheral quantitative computed tomography

SD

Standard deviation

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • L. M. Ward
    • 1
    • 2
  • J. Ma
    • 1
    • 3
  • F. Rauch
    • 4
  • E. I. Benchimol
    • 2
    • 3
    • 5
  • J. Hay
    • 6
  • M. B. Leonard
    • 7
  • M. A. Matzinger
    • 8
  • N. Shenouda
    • 8
  • B. Lentle
    • 9
  • H. Cosgrove
    • 1
  • M. Scharke
    • 1
  • V. N. Konji
    • 1
  • D. R. Mack
    • 2
    • 5
  1. 1.Pediatric Bone Health Clinical Research ProgramChildren’s Hospital of Eastern Ontario Research InstituteOttawaCanada
  2. 2.Department of PediatricsUniversity of Ottawa, Children’s Hospital of Eastern OntarioOttawaCanada
  3. 3.School of Epidemiology, Public Health and Preventive MedicineUniversity of OttawaOttawaCanada
  4. 4.Shriners Hospital for Children, Department of PediatricsMcGill UniversityMontrealCanada
  5. 5.Children’s Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and NutritionChildren’s Hospital of Eastern OntarioOttawaCanada
  6. 6.Department of Health SciencesBrock UniversitySt. CatharinesCanada
  7. 7.Department of PediatricsStanford University School of MedicinePalo AltoUSA
  8. 8.Department of Medical ImagingChildren’s Hospital of Eastern Ontario and University of OttawaOttawaCanada
  9. 9.Department of RadiologyUniversity of British ColumbiaVancouverCanada

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