Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Nutrients. 2023 Dec 8;15(24):5048. doi: 10.3390/nu15245048.
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract with an increasing worldwide incidence. IBD is frequently diagnosed during childhood in the adolescent period of ongoing growth and development, and it can affect patients' linear growth, puberty, nutrition, and bone health. Therefore, its treatment and monitoring are critical to prevent secondary outcomes. However, few studies have highlighted the association between pediatric IBD and skeletal outcomes in Asian populations. We aimed to identify the prevalence and risk factors for low bone mineral density (BMD) in Korean children and adolescents with newly diagnosed IBD. Patients aged 10-18 years diagnosed with either Crohn's disease (CD) or ulcerative colitis (UC) who underwent lumbar spine bone mineral density (LSBMD) and femoral bone mineral density (FBMD) analyses via dual-energy X-ray absorptiometry at the time of IBD diagnosis were included. Low BMD was considered when the age- and sex-matched BMD -score was <-1.0. The LSBMD and FBMD -scores were correlated with clinical parameters, including general characteristics, anthropometry, and IBD-associated laboratory markers. Regression analyses were performed to identify the risk factors for low BMD. Although the general characteristics between CD ( = 42) and UC ( = 9) groups did not differ, the mean -scores of LSBMD and FBMD of the 51 subjects were -0.11 ± 1.24 and -0.58 ± 1.38, respectively. Furthermore, 7.8% and 18% of the study subjects had LSBMD and FBMD -scores < -2.0, whereas more than 50% had scores of 0--1.0. Among the clinical factors, body mass index (BMI) -score, duration of clinical manifestations, and serum alanine aminotransferase and selenium levels were associated with LSBMD -scores in the final multivariate regression analyses. Odds ratios of BMI < -2.0 standard deviation for low LSBMD and FBMD -scores were 31.97 and 41.45, respectively. A BMI -score < -0.93 was determined as the best cut-off for predicting low BMD. In newly diagnosed pediatric IBD, a substantial number of children are likely to have low BMD in prior to initial treatment while lower BMI, longer duration of clinical manifestation, and higher selenium concentration could affect initial BMD status. Routine bone health surveillance from initial IBD diagnosis throughout the treatment's completion is recommended for preventing the early development of secondary osteoporosis.
炎症性肠病 (IBD) 是一种胃肠道慢性炎症性疾病，全球发病率呈上升趋势。IBD 常在青少年生长发育期间被诊断出来，它会影响患者的线性生长、青春期、营养和骨骼健康。因此，对其进行治疗和监测对于预防继发性后果至关重要。然而，很少有研究强调儿科 IBD 与亚洲人群骨骼结果之间的关联。我们旨在确定新诊断为 IBD 的韩国儿童和青少年中低骨密度 (BMD) 的患病率和危险因素。纳入年龄在 10-18 岁、经双能 X 线吸收法测定腰椎骨密度 (LSBMD) 和股骨骨密度 (FBMD) 的诊断为克罗恩病 (CD) 或溃疡性结肠炎 (UC) 的患者。当年龄和性别匹配的 BMD 评分 <-1.0 时，考虑低 BMD。LSBMD 和 FBMD 评分与临床参数相关，包括一般特征、人体测量学和与 IBD 相关的实验室标志物。进行回归分析以确定低 BMD 的危险因素。虽然 CD（n=42）和 UC（n=9）组之间的一般特征没有差异，但 51 名受试者的 LSBMD 和 FBMD 平均评分分别为-0.11±1.24 和-0.58±1.38。此外，7.8%和 18%的研究对象的 LSBMD 和 FBMD 评分<-2.0，而超过 50%的研究对象的评分在 0-1.0 之间。在临床因素中，体质指数 (BMI) 评分、临床表现持续时间以及血清丙氨酸氨基转移酶和硒水平与最终多变量回归分析中的 LSBMD 评分相关。BMI<-2.0 标准差的低 LSBMD 和 FBMD 评分的比值比分别为 31.97 和 41.45。BMI<-0.93 被确定为预测低 BMD 的最佳截断值。在新诊断的儿科 IBD 中，相当数量的儿童在开始治疗之前可能存在低 BMD，而较低的 BMI、较长的临床表现持续时间和较高的硒浓度可能会影响初始 BMD 状态。建议从初始 IBD 诊断开始到治疗完成后，对骨骼健康进行常规监测，以预防继发性骨质疏松症的早期发生。
