Levy-Shraga Yael, Shenkar Anatoly, Modan-Moses Dalit, Assa Amit, Haberman Yael, Shouval Dror, Guz-Mark Anat, Lahad Avishay, Weiss Batia
Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.
The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Acta Paediatr. 2020 May;109(5):1026-1032. doi: 10.1111/apa.15046. Epub 2019 Oct 27.
Children with inflammatory bowel disease (IBD) are prone to low bone mineral density (BMD). Our aim was to assess longitudinal changes in BMD in this population.
A retrospective longitudinal study of children with IBD, treated at two tertiary centres in Israel, who underwent two BMD measurements by dual-energy X-ray absorptiometry (DXA). Changes in lumbar spine BMD (∆L1-4 z-scores) were examined for correlations with clinical characteristics.
The cohort included 41 patients (age at diagnosis 12.1 ± 3.5 years, 23 females).The mean interval between the scans was 3.4 ± 2.0 years. There was a trend towards improvement in L1-4 z-scores (-1.64 ± 1.02 vs -1.45 ± 0.83, P = .12). ∆L1-4 z-scores correlated positively with ∆weight-standard deviation scores (SDS), ∆height-SDS and ∆BMI-SDS, and with age at the second scan (R = .55, P < .01; R = .42, P < .01; R = .42, P = .01; R = .35, P = .02, respectively); and negatively with L1-4 z-scores at the first scan (R = -.63, P < .01). Stepwise linear regression analysis identified the first scan L1-4 z-scores and ∆weight-SDS as independent predictors of ∆L1-4 z-scores. An L1-4 z-score ≤-2 at the first DXA scan was associated with significant improvement at the second scan.
Improvement in BMD was more pronounced in children who gained weight or whose BMD was low at the first scan.
炎症性肠病（IBD）患儿易于出现低骨矿物质密度（BMD）。我们的目的是评估该人群中BMD的纵向变化。
对在以色列两个三级中心接受治疗的IBD患儿进行回顾性纵向研究，这些患儿通过双能X线吸收法（DXA）进行了两次BMD测量。检查腰椎BMD的变化（∆L1-4 z评分）与临床特征的相关性。
该队列包括41例患者（诊断时年龄12.1±3.5岁，23例女性）。两次扫描之间的平均间隔为3.4±2.0年。L1-4 z评分有改善趋势（-1.64±1.02对-1.45±0.83，P = 0.12）。∆L1-4 z评分与∆体重标准差评分（SDS）、∆身高-SDS和∆BMI-SDS以及第二次扫描时的年龄呈正相关（R = 0.55，P < 0.01；R = 0.42，P < 0.01；R = 0.42，P = 0.01；R = 0.35，P = 0.02）；与第一次扫描时的L1-4 z评分呈负相关（R = -0.63，P < 0.01）。逐步线性回归分析确定第一次扫描时的L1-4 z评分和∆体重-SDS是∆L1-4 z评分的独立预测因素。第一次DXA扫描时L1-4 z评分≤-2与第二次扫描时的显著改善相关。
体重增加或第一次扫描时BMD较低的儿童BMD改善更为明显。
