Open AccessInflammation is the main determinant of low bone mineral density in pediatric inflammatory bowel disease
Author(s) -
Paganelli Massimiliano,
Albanese Carlina,
Borrelli Osvaldo,
Civitelli Fortunata,
Canitano Nicoletta,
Viola Franca,
Passariello Roberto,
Cucchiara Salvatore
Publication year - 2007
Publication title -
inflammatory bowel diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.932
H-Index - 146
eISSN - 1536-4844
pISSN - 1078-0998
DOI - 10.1002/ibd.20039
Subject(s) - medicine , inflammatory bowel disease , ulcerative colitis , infliximab , gastroenterology , bone mineral , inflammation , disease , osteoporosis
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‐α, 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‐α, 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. (Inflamm Bowel Dis 2007)