Risk Factors for Low Bone Mineral Density in Children and Adolescents with Inflammatory Bowel Disease

• Published in: Digestive diseases and sciences 2008-10, Vol.53 (10), p.2746-2753
• Main Authors: Lopes, Letícia Helena Caldas, Sdepanian, Vera Lucia, Szejnfeld, Vera Lúcia, de Morais, Mauro Batista, Fagundes-Neto, Ulysses
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Adolescent; Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - pharmacology; Adrenal Cortex Hormones - therapeutic use; Biochemistry; Biological and medical sciences; Body Height; Body Mass Index; Bone Density - drug effects; Bone Density - physiology; Brazil - epidemiology; Calcium - pharmacology; Child; Child, Preschool; Dose-Response Relationship, Drug; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatology; Humans; Inflammatory bowel disease; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - drug therapy; Inflammatory Bowel Diseases - physiopathology; Investigative techniques, diagnostic techniques (general aspects); Linear Models; Lumbar Vertebrae - physiopathology; Male; Medical sciences; Medicine; Medicine & Public Health; Oncology; Original Paper; Osteoarticular system. Muscles; Osteoporosis - epidemiology; Osteoporosis - physiopathology; Other diseases. Semiology; Prevalence; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Transplant Surgery; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-008-0223-0

Objective To evaluate bone mineral density of the lumbar spine in children and adolescents with inflammatory bowel disease, and to identify the clinical risk factors associated with low bone mineral density. Methods Bone mineral density of the lumbar spine was evaluated using dual-energy X-ray absorptiometry (DXA) in 40 patients with inflammatory bowel disease. Patients were 11.8 (SD = 4.1) years old and most of them were male (52.5%). Multiple linear regression analysis was performed to identify potential associations between bone mineral density Z-score and age, height-for-age Z-score, BMI Z-score, cumulative corticosteroid dose in milligrams and in milligrams per kilogram, disease duration, number of relapses, and calcium intake according to the dietary reference intake. Results Low bone mineral density (Z-score bellow −2) was observed in 25% of patients. Patients with Crohn’s disease and ulcerative colitis had equivalent prevalence of low bone mineral density. Multiple linear regression models demonstrated that height-for-age Z-score, BMI Z-score, and cumulative corticosteroid dose in mg had independent effects on BMD, respectively, β  = 0.492 ( P  = 0.000), β  = 0.460 ( P  = 0.001), β  = –0.014 ( P  = 0.000), and these effects remained significant after adjustments for disease duration, respectively, β  = 0.489 ( P  = 0.013), β  = 0.467 ( P  = 0.001), and β  = −0.005 ( P  = 0.015). The model accounted for 54.6% of the variability of the BMD Z-score (adjusted R 2 = 0.546). Conclusions The prevalence of low bone mineral density in children and adolescents with inflammatory bowel disease is considerably high and independent risk factors associated with bone mineral density are corticosteroid cumulative dose in milligrams, height-for-age Z-score, and BMI Z-score.