New research from the University of Gothenburg in Sweden shows that low bone mineral density is common in children and adolescents with inflammatory bowel disease.
New research from the University of Gothenburg in Sweden shows that low bone mineral density (BMD) is common in children and adolescents with inflammatory bowel disease (IBD).
The findings, which are published in a thesis written by researchers at the Institute of Clinical Sciences, underscore the importance of treating the underlying inflammatory bowel disease more effectively, and of measuring bone mineral density in young patients.
For the study—which is the first in Scandinavia to examine the occurrence of low BMD in this population— Susanne Schmidt and colleagues observed 144 patients between the ages of six and 19 with inflammatory bowel disease in western Sweden. The aims of the thesis were to investigate BMD, body composition, and growth over a two-year period, and to study the familial resemblance of BMD in pediatric patients with IBD.
“The mechanisms behind reduced BMD in pediatric IBD are still not completely understood,” wrote the authords, but several factors that influence bone mineralization have been suggested, including the chronic inflammation itself, which causes the release of cytokines from the inflamed bowel, treatment with corticosteroids, low body weight, limited physical activity, vitamin D deficiency and genetics. Schmidt and colleagues hypothesized that “decreased peak bone mass in young adulthood may predispose for the development of osteoporosis later in life and this in turn may lead to osteoporosis-related fractures.”
To evaluate BMD and body composition, participants and their parents underwent dual-energy X-ray absorptiometry (DXA) at the time of inclusion in the study; two years later the DXA measurement was repeated in the IBD patients. Researchers also obtained clinical data, body weight, height, Tanner stage, bone age, and blood samples for various hormone analyses, and calculated age at peak height velocity using special software.
The researchers found that around half of the patients demonstrated signs of low BMD, both at baseline and at follow-up two years later, which risk factors for BMD being identified as male gender, low BMI and treatment with azathioprine.
However, they also determined that both males and females have the potential to recover BMD into early adulthood, and that “regardless of the presence of a chronic inflammatory condition, the BMD of children and adolescents with IBD is significantly related to that of their parents.”
Schmidt and colleagues concluded that “the data from this thesis support the conclusion that pediatric patients with IBD should be evaluated with DXA at some point during the course of their disease, if possible soon after being diagnosed.”