Nobile Stefano, Grand Richard J, Pappa Helen M
Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy.
Harvard Medical School, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts.
Eur J Gastroenterol Hepatol. 2018 Apr;30(4):471-476. doi: 10.1097/MEG.0000000000001076.
In pediatric inflammatory bowel disease (IBD), the prevalence of low bone mineral density (BMD) and bone fractures and the relationship between these are still debated. Our aim was to report data from a cohort of pediatric patients with IBD.
Cross-sectional assessment of growth and BMD [(dual-energy x-ray absorptiometry (DXA)] and retrospective chart review were performed to report the lifetime prevalence of bone fractures and clinical associations with patients' data.
We examined 216 patients with IBD, 8-25 years old (median: 14 years). Low BMD was found in 12.5% (spine) and 27% (total body). Multiple regression analysis showed that BMD was predicted by Z-scores for height and weight at DXA. History of menstrual irregularities and nasogastric tube feedings was associated with lower BMD, whereas physical activity and higher Z-score for height at DXA were associated with higher BMD.The prevalence of lifetime fractures was 11.8%. Patients with a history of fractures had lower Z-scores for spine BMD (-1.20 vs. -0.69, P=0.020) and total-body BMD (-1.30 vs. -0.75, P=0.014) compared with those without a history of fractures. Patients with spine BMD Z-score of up to -2 SD score had significantly increased prevalence of fractures compared with those with Z-score more than -2 SD score (28 vs. 10%, P=0.015).
This study provides further insight into risk factors for low BMD in pediatric IBD. Novel findings were the association between low BMD and fractures, and the positive relationship between BMD and physical activity.
在儿童炎症性肠病（IBD）中，低骨矿物质密度（BMD）和骨折的患病率以及二者之间的关系仍存在争议。我们的目的是报告一组儿童IBD患者的数据。
对生长情况和BMD[双能X线吸收法（DXA）]进行横断面评估，并回顾性查阅病历，以报告骨折的终生患病率以及与患者数据的临床关联。
我们检查了216例8至25岁（中位数：14岁）的IBD患者。发现12.5%（脊柱）和27%（全身）的患者存在低BMD。多元回归分析表明，DXA时的身高和体重Z评分可预测BMD。月经不规律和鼻胃管喂养史与较低的BMD相关，而体育活动和DXA时较高的身高Z评分与较高的BMD相关。终生骨折患病率为11.8%。有骨折史的患者与无骨折史的患者相比，脊柱BMD的Z评分更低（-1.20对-0.69，P=0.020），全身BMD的Z评分也更低（-1.30对-0.75，P=0.014）。脊柱BMD Z评分高达-2标准差的患者与Z评分高于-2标准差的患者相比，骨折患病率显著增加（28%对10%，P=0.015）。
本研究进一步深入了解了儿童IBD中低BMD的危险因素。新发现是低BMD与骨折之间的关联以及BMD与体育活动之间的正相关关系。
