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Impaired Bone Health in Inflammatory Bowel Disease: A Case–Control Study in 80 Pediatric Patients

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Abstract

Previous studies have indicated that children with inflammatory bowel disease (IBD) may not achieve optimal bone mass. We evaluated the skeletal characteristics in children and adolescents with IBD. This cross-sectional cohort study comprised 80 IBD patients (median age 14.9 years, range 5–20) with a median disease duration of 3.4 years; 51 had ulcerative colitis, 26 Crohn disease, and 3 unspecified colitis. Eighty age- and gender-matched healthy subjects served as controls. Areal bone mineral density (aBMD), body composition, and vertebral fractures (VFs) were assessed by DXA. Bone age (BA) was determined for IBD patients. Findings were correlated with disease- and treatment-related parameters and biochemistry. IBD patients had lower BA-adjusted lumbar spine and whole-body aBMD (p < 0.001 for both) and whole-body BMC adjusted for height (p = 0.02) than controls. Lean mass and fat mass Z scores did not differ between the groups, but IBD patients had lower whole-body BMC relative to muscle mass (p = 0.006). Despite vitamin D supplementation in 48 %, vitamin D deficiency was common. In IBD cumulative weight-adjusted prednisolone dose >150 mg/kg for the preceding 3 years increased the risk for low whole-body aBMD (OR = 5.5, 95 % CI 1.3–23.3, p = 0.02). VFs were found in 11 % of patients and in 3 % of controls (p = 0.02). IBD in childhood was associated with low aBMD and reduced bone mass accrual relative to muscle mass; the risk for subclinical VFs may be increased. These observations warrant careful follow-up and active preventive measures.

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Acknowledgement

We thank research nurse Päivikki Rissanen for her skillful assistance. This study was supported by grants from the Sigrid Juselius Foundation, the Finnish Medical Foundation, the Finnish Foundation for Pediatric Research, the Academy of Finland, and the Helsinki University Hospital Research Funds.

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Authors and Affiliations

  1. Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, P.O. Box 281, 00029, Helsinki, Finland

    Saila Laakso, Helena Valta, Matti Verkasalo, Heli Viljakainen & Outi Mäkitie

  2. Helsinki Medical Imaging Center, Department of Pediatric Radiology, Helsinki University Central Hospital, Helsinki, Finland

    Sanna Toiviainen-Salo

Authors
  1. Saila Laakso
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  2. Helena Valta
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  3. Matti Verkasalo
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  4. Sanna Toiviainen-Salo
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  5. Heli Viljakainen
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  6. Outi Mäkitie
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Correspondence to Saila Laakso.

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The authors have stated that they have no conflict of interest.

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Laakso, S., Valta, H., Verkasalo, M. et al. Impaired Bone Health in Inflammatory Bowel Disease: A Case–Control Study in 80 Pediatric Patients. Calcif Tissue Int 91, 121–130 (2012). https://doi.org/10.1007/s00223-012-9617-2

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  • DOI: https://doi.org/10.1007/s00223-012-9617-2

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