Inflammation is the main determinant of low bone mineral density in pediatric inflammatory bowel disease
✍ Scribed by Massimiliano Paganelli; Carlina Albanese; Osvaldo Borrelli; Fortunata Civitelli; Nicoletta Canitano; Franca Viola; Roberto Passariello; Salvatore Cucchiara
- Publisher
- John Wiley and Sons
- Year
- 2007
- Tongue
- English
- Weight
- 220 KB
- Volume
- 13
- Category
- Article
- ISSN
- 1078-0998
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✦ Synopsis
Aims:
To assess bone mineral density (bmd) in children with crohn's disease (cd) and ulcerative colitis (uc) and to investigate the role of inflammation and steroids on bmd.
Methods:
Lumbar spine areal bmd was measured by dxa, and volumetric bmd was then estimated (bmad); inflammatory cytokines (tnf-alpha, il-6, il-10, and il-12) were dosed in peripheral blood; and cumulative and daily doses of steroids were calculated. therapy with infliximab (ifx) was considered for cd patients.
Results:
Fifty-six patients with ibd (35 cd, 21 uc) were studied. an inverse correlation was found between bmad and il-6 in patients with uc (r = -0.65); no correlation was found between bmad and serum levels of tnf-alpha, il-10, and il-12 in all patients. disease activity indexes use inversely correlated with bmad (r = -0.62 in patients with cd and r = -0.64 in patients with uc). cumulative dose of corticosteroids and duration of therapy did not correlate with bmad. the 10 patients with cd who were treated with ifx had higher bmad (-1 +/- 0.8) than those never treated with ifx (-1.8 +/- 0.8). mean pediatric crohn's disease activity index and body mass index in patients with cd (r(2) = 0.48) and il-6 level in patients with uc (r(2) = 0.43) were found to be independent and significant predictors of bmad.
Conclusions:
In children with ibd, inflammation is an important determinant of bone loss, as shown by the correlation of bmad with serum il-6 and with disease activity indexes as well as by the beneficial effect of ifx on bone density. corticosteroids seem to be a less important variable in pediatric ibd-related bmd reduction than previously believed.