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Musculoskeletal system in children and adolescents with inflammatory bowel disease: normal muscle force, decreased trabecular bone mineral density and low prevalence of vertebral fractures

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Abstract

Low bone mineral density (BMD) and an increased fracture incidence are two extraintestinal complications associated with inflammatory bowel disease (IBD). We aimed to evaluate musculoskeletal traits and assess vertebral fracture (VF) rate in children and adolescents with IBD. Seventy patients with IBD with a median age of 13.8 years were included. The BMD and geometric parameters of the non-dominant tibia were assessed using pQCT. Dynamic muscle functions were evaluated using jumping mechanography. VFs were assessed according to the semiquantitative standardized method by Genant. The muscle functions adjusted for the patients’ weight did not differ from the reference population. A low trabecular BMD (Z-score − 1.6; p < 0.001) and cortical thickness (Z-score − 0.7; p < 0.001) were found in children and adolescents with IBD. Conversely, an increased cortical BMD (Z-score 1.1; p < 0.001) was noted. No significant association was found between the 25-OHD serum levels and the bone or muscle measurements. One patient with asymptomatic VF was identified.

Conclusion: IBD in childhood or adolescents affects bones but not muscles. Bone changes are independent of the 25-OHD serum level. A thoracolumbar spine X-ray should not be routinely recommended in children with IBD.

What is Known:

• Low bone mineral density and an increased fracture rate are the complications associated with IBD.

• Bone strength and structural development is strongly dependent on skeletal muscle stimulation.

What is New:

• Children with IBD have altered bone density and geometry but normal dynamic muscle functions.

• Thoracolumbar spine X-ray should be indicated on an individual basis in children with IBD.

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Abbreviations

25-OHD:

25-hydroxycholecalciferol

BMC:

Bone mineral content

BMD:

Bone mineral density

BMI:

Body mass index

CRP:

C-reactive protein

CSA:

Cross-sectional area

DXA:

Dual energy X-ray absorptiometry

F-calprotectin:

Fecal calprotectin

IBD:

Inflammatory bowel disease

M1LH:

Multiple one-legged hopping

PCDAI:

Pediatric Crohn’s Disease Activity Index

pQCT:

Peripheral quantitative computed tomography

PTH:

Parathormone

PUCAI:

Pediatric Ulcerative Colitis Activity Index

S2LJ:

Single two-legged jump

SSI:

Polar strength strain index

VF:

Vertebral fracture

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Acknowledgements and funding

We would like to acknowledge all patients and their families who have participated in this study. Many thanks to Dr. Renata Mynarova for her expert vertebral fracture assessment as well as for scoring the deformities according to Genant.

This project was partially supported by the Ministry of Health, Czech Republic (Project for conceptual development of research organization 00064203; Motol University Hospital, Prague, Czech Republic) and by the Charles University Grant Agency (GAUK No. 136215, and No. 246216).

Authors’Contributions

Klara Maratova and Jana Matyskova performed the pQCT and mechanography assessment. Ondrej Hradsky provided the statistical analyses. Ivana Copova, Ondrej Hradsky, and Jiri Bronsky recruited the patients. Ondrej Soucek, Zdenek Sumnik, and Klara Maratova were responsible for interpretation of the data and drafted the paper. All co-authors revised the final version of the manuscript and approved it for publication.

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Authors and Affiliations

  1. Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Czech Republic

    Klara Maratova, Ondrej Hradsky, Jana Matyskova, Ivana Copova, Ondrej Soucek, Zdenek Sumnik & Jiri Bronsky

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  1. Klara Maratova
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Correspondence to Ondrej Soucek.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Communicated by Peter de Winter

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Maratova, K., Hradsky, O., Matyskova, J. et al. Musculoskeletal system in children and adolescents with inflammatory bowel disease: normal muscle force, decreased trabecular bone mineral density and low prevalence of vertebral fractures. Eur J Pediatr 176, 1355–1363 (2017). https://doi.org/10.1007/s00431-017-2988-7

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