Collen Lauren V, Snapper Scott B, Gordon Rebecca J
Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
JPGN Rep. 2023 Jan 19;4(1):e283. doi: 10.1097/PG9.0000000000000283. eCollection 2023 Feb.
To describe clinical characteristics and outcomes of 3 patients with very early onset inflammatory bowel disease (VEOIBD) and vertebral compression fractures.
Patients with VEOIBD receiving care at a single tertiary center were prospectively enrolled in a longitudinal data repository. Retrospective chart review was performed to identify clinical characteristics and comorbidities. Those with clinically apparent vertebral compression fractures subsequently underwent an additional chart review focused on bone health.
Three out of 216 (1.4%) patients with VEOIBD had symptomatic vertebral compression fractures. Of the 3 patients with vertebral compression fractures, all had Crohn's disease, 2 had monogenic inflammatory bowel disease, and all reported back pain. One patient notably had a normal dual-energy X-ray absorptiometry, highlighting a potential limitation of dual-energy X-ray absorptiometry to identify increased skeletal fragility in this population. Risk factors for suboptimal bone health included chronic inflammation secondary to poorly controlled inflammatory bowel disease, substantial glucocorticoid exposure, chronic use of other medications associated with suboptimal bone health including proton pump inhibitors and granulocyte colony-stimulating factor, and solid organ transplant. Patients treated with bisphosphonates had improved clinical outcomes, with resolution of back pain and increased bone mineral density.
Vertebral compression fracture should be considered in the differential diagnosis of patients with VEOIBD and back pain, especially in those with other risk factors for suboptimal bone health. Treatment of compression fractures with bisphosphonates resulted in resolution of back pain and improved bone density.
描述3例极早发型炎症性肠病（VEOIBD）合并椎体压缩骨折患者的临床特征及预后。
在单一三级中心接受治疗的VEOIBD患者被前瞻性纳入纵向数据储存库。进行回顾性病历审查以确定临床特征和合并症。对有临床明显椎体压缩骨折的患者随后进行了一次额外的侧重于骨骼健康的病历审查。
216例VEOIBD患者中有3例（1.4%）出现有症状的椎体压缩骨折。在这3例椎体压缩骨折患者中，均患有克罗恩病，2例患有单基因炎症性肠病，且均报告有背痛。1例患者的双能X线吸收法检查结果正常，这突出了双能X线吸收法在识别该人群骨骼脆性增加方面的潜在局限性。骨骼健康欠佳的风险因素包括炎症性肠病控制不佳继发的慢性炎症、大量糖皮质激素暴露、长期使用其他与骨骼健康欠佳相关的药物（包括质子泵抑制剂和粒细胞集落刺激因子）以及实体器官移植。接受双膦酸盐治疗的患者临床预后改善，背痛缓解且骨密度增加。
在VEOIBD且有背痛的患者鉴别诊断中应考虑椎体压缩骨折，尤其是那些有其他骨骼健康欠佳风险因素的患者。用双膦酸盐治疗压缩骨折可使背痛缓解且骨密度改善。
