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Changes in trabecular bone density in incident pediatric Crohn’s disease: a comparison of imaging methods

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Abstract

Summary

This study of changes in dual energy x-ray absorptiometry (DXA) spine BMD following diagnosis and treatment for childhood Crohn’s disease demonstrated that changes in conventional posteroanterior BMD results were confounded by impaired growth, and suggested that lateral spine measurements and strategies to estimate volumetric BMD were more sensitive to disease and treatment effects.

Introduction

We previously reported significant increases in peripheral quantitative CT (pQCT) measures of trabecular volumetric bone mineral density (vBMD) following diagnosis and treatment of pediatric Crohn’s disease (CD). The objective of this study was to compare pQCT trabecular vBMD and three DXA measures of spine BMD in this cohort: (1) conventional posteroanterior BMD (PA-BMD), (2) PA-BMD adjusted for height Z (PA-BMDHtZ), and (3) width-adjusted volumetric BMD (WA-BMD) estimated from PA and lateral scans.

Methods

Spine DXA [lumbar (L1–4) for posteroanterior and L3 for lateral] and tibia pQCT scans were obtained in 65 CD subjects (ages 7–18 years) at diagnosis and 12 months later. BMD results were converted to sex, race, and age-specific Z-scores based on reference data in >650 children (ages 5–21 years). Multivariable linear regression models identified factors associated with BMD Z-scores.

Results

At CD diagnosis, all BMD Z-scores were lower compared with the reference children (all p values <0.01). The pQCT vBMD Z-scores (−1.46 ± 1.30) were lower compared with DXA PA-BMD (−0.75 ± 0.98), PA-BMDHtZ (−0.53 ± 0.87), and WA-BMD (−0.61 ± 1.10) among CD participants. Only PA-BMD Z-scores were correlated with height Z-scores at baseline (R = 0.47, p < 0.0001). pQCT and WA-BMD Z-scores increased significantly over 12 months to −1.04 ± 1.26 and −0.20 ± 1.14, respectively. Changes in all four BMD Z-scores were positively associated with changes in height Z-scores (p < 0.05). Glucocorticoid doses were inversely associated with changes in WA-BMD (p < 0.01) only.

Conclusions

Conventional and height Z-score-adjusted PA DXA methods did not demonstrate the significant increases in trabecular vBMD noted on pQCT and WA-BMD scans. WA-BMD captured glucocorticoid effects, potentially due to isolation of the vertebral body on the lateral projection. Future studies are needed to identify the BMD measure that provides greatest fracture discrimination in CD.

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Acknowledgments

We greatly thank the children and their families who participated in this study for their dedication and the physicians and nurses in the Division of Gastroenterology at the Children’s Hospital of Philadelphia. This project was supported by grants R01-DK060030, K24-DK076808, and UL1-RR-024134 from the National Center for Research Resources. Dr. Berkenstock was supported by the Society of Pediatric Research, Dr. Tsampalieros by the University of Ottawa, Faculty of Medicine, and Dr. Griffin by the Doris Duke Clinical Research Foundation.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Pediatrics, The Children’s Hospital of Eastern Ontario, Faculty of Medicine, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8 L1, Canada

    A. Tsampalieros

  2. Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA

    A. Tsampalieros, B. S. Zemel, J. M. Burnham, R. N. Baldassano & M. B. Leonard

  3. Department of Ophthalmology, Drexel University College of Medicine, 219 N. Broad St. 3rd Floor, Philadelphia, PA, 19107, USA

    M. K. Berkenstock

  4. Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY, 10016, USA

    L. Griffin

  5. Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA

    J. Shults & M. B. Leonard

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  1. A. Tsampalieros
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Correspondence to M. B. Leonard.

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Tsampalieros, A., Berkenstock, M.K., Zemel, B.S. et al. Changes in trabecular bone density in incident pediatric Crohn’s disease: a comparison of imaging methods. Osteoporos Int 25, 1875–1883 (2014). https://doi.org/10.1007/s00198-014-2701-x

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  • DOI: https://doi.org/10.1007/s00198-014-2701-x

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