Whole Body BMC in Pediatric Crohn Disease: Independent Effects of Altered Growth, Maturation, and Body Composition

Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Journal of Bone and Mineral Research (Impact Factor: 6.83). 12/2004; 19(12):1961-8. DOI: 10.1359/JBMR.040908
Source: PubMed

ABSTRACT

Whole body BMC was assessed in 104 children and young adults with CD and 233 healthy controls. CD was associated with significant deficits in BMC and lean mass, relative to height. Adjustment for lean mass eliminated the bone deficit in CD. Steroid exposure was associated with short stature but not bone deficits relative to height.
Children with Crohn disease (CD) have multiple risk factors for impaired bone accrual. The confounding effects of poor growth and delayed maturation limit the interpretation of prior studies of bone health in CD. The objective of this study was to assess BMC relative to growth, body composition, and maturation in CD compared with controls.
Whole body BMC and lean mass were assessed by DXA in 104 CD subjects and 233 healthy controls, 4-26 years of age. Multivariable linear regression models were developed to sequentially adjust for differences in skeletal size, pubertal maturation, and muscle mass. BMC-for-height z scores were derived to determine CD-specific covariates associated with bone deficits.
Subjects with CD had significantly lower height z score, body mass index z score, and lean mass relative to height compared with controls (all p < 0.0001). After adjustment for group differences in age, height, and race, the ratio of BMC in CD relative to controls was significantly reduced in males (0.86; 95% CI, 0.83, 0.94) and females (0.91; 95% CI, 0.85, 0.98) with CD. Adjustment for pubertal maturation did not alter the estimate; however, addition of lean mass to the model eliminated the bone deficit. Steroid exposure was associated with short stature but not bone deficits.
This study shows the importance of considering differences in body size and composition when interpreting DXA data in children with chronic inflammatory conditions and shows an association between deficits in muscle mass and bone in pediatric CD.

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    • "Specific pediatric populations are known to be at high risk for a low bone density, including children and adolescents with cerebral palsy and other non-ambulatory states [1-4], chronic renal failure [5], malnutrition and malabsorptive states [6-8], cystic fibrosis [9-11], pubertal delay [12], and 25-hydroxyvitamin D (25OHD) deficiency [13,14]. In addition, medical therapies such as treatment with anticonvulsants [15], glucocorticoids [15], and chemotherapy [16,17] are associated with a compromise of bone density. "
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    ABSTRACT: Background To identify factors that predict low bone mineral density (BMD) in pediatric patients referred for dual-energy x-ray absorptiometry assessments. Methods This is a retrospective cohort study of 304 children and adolescents referred for dual-energy x-ray absorptiometry assessments at a tertiary care center. Outcomes included risk factors which predicted a significant low bone density for age, defined as BMD Z-score ≤ -2.0 SD. A univariate analysis involved Chi-square, Fisher’s Exact test, and analysis of variance, and multivariate logistic regression models were constructed to determine predictors of low bone mineral density. Results In the multivariate logistic regression model, predictors of low bone mineral density included low body mass index Z-score (odds ratio 0.52, 95% confidence interval 0.39 – 0.69), low height Z-score (OR 0.71, 95% CI 0.57 – 0.88), vitamin D insufficiency (OR 3.97, 95% CI 2.08 – 7.59), and history of bone marrow transplant (OR 5.78, 95% CI 1.00 – 33.45). Conclusions Underlying health problems and associated treatments can impair bone mineral accrual. We identified risk factors most predictive of low bone mineral density in subjects referred for bone density measurement. Recognition of these factors may allow for earlier assessment to maximize bone mass in at-risk children.
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