Iliac bone histomorphometry in children with newly diagnosed inflammatory bowel disease
Tóm tắt
Children with inflammatory bowel disease (IBD) manifest low bone mass; the cause remains unclear. We performed transilial bone biopsies in 20 IBD children at diagnosis and found a mild cortical bone deficit and slow bone turnover. It is possible that low mechanical stimulation due to inadequate muscle mass contributes to the bone deficit. Children with newly diagnosed IBD can have low bone mineral density and disturbed bone metabolism, but the tissue level characteristics of the bone involvement in pediatric IBD have not been elucidated. In the present study, we evaluated the skeletal status, including static histomorphometry on transiliac bone samples, in 20 patients (age range 8.4 to 17.7 years, 12 boys) with newly diagnosed IBD and compared results to published normative data. Despite normal height (mean Z-score 0.04, SD 1.2), areal bone mineral density at the lumbar spine was moderately low (mean age- and sex-specific Z-score −0.8, SD 1.1). Total body bone mineral content and lean mass were low for age and sex as well (mean Z-scores −1.2, SD 0.9 and −2.0, SD 0.9, respectively). Biochemical bone markers indicated low bone formation and resorption activity. Bone histomorphometry revealed a slightly low cortical width (mean 23%, SD 25%, below the result expected for age) but a normal amount of trabecular bone. The percentage of trabecular bone surface covered by osteoid or osteoclasts was low, suggesting that both bone formation and bone resorption were suppressed. Our results indicate that young patients manifest a mild cortical bone deficit at the iliac crest and slow trabecular bone turnover even at diagnosis, in the setting of IBD.
Tài liệu tham khảo
Kim SC, Ferry GD (2004) Inflammatory bowel diseases in pediatric and adolescent patients: clinical, therapeutic, and psychosocial considerations. Gastroenterology 126:1550–1560
Sylvester FA, Wyzga N, Hyams JS, Davis PM, Lerer T, Vance K, Hawker G, Griffiths AM (2007) Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease. Inflamm Bowel Dis 13:42–50
Harpavat M, Greenspan SL, O’Brien C, Chang CC, Bowen A, Keljo DJ (2005) Altered bone mass in children at diagnosis of Crohn disease: a pilot study. J Pediatr Gastroenterol Nutr 40:295–300
Thearle M, Horlick M, Bilezikian JP, Levy J, Gertner JM, Levine LS, Harbison M, Berdon W, Oberfield SE (2000) Osteoporosis: an unusual presentation of childhood Crohn’s disease. J Clin Endocrinol Metab 85:2122–2126
Sylvester FA, Wyzga N, Hyams JS, Gronowicz GA (2002) Effect of Crohn’s disease on bone metabolism in vitro: a role for interleukin-6. J Bone Miner Res 17:695–702
Varghese S, Wyzga N, Griffiths AM, Sylvester FA (2002) Effects of serum from children with newly diagnosed Crohn disease on primary cultures of rat osteoblasts. J Pediatr Gastroenterol Nutr 35:641–648
Pappa HM, Gordon CM, Saslowsky TM, Zholudev A, Horr B, Shih MC, Grand RJ (2006) Vitamin D status in children and young adults with inflammatory bowel disease. Pediatrics 118:1950–1961
Gupta A, Paski S, Issenman R, Webber C (2004) Lumbar spine bone mineral density at diagnosis and during follow-up in children with IBD. J Clin Densitom 7:290–295
Tuchman S, Thayu M, Shults J, Zemel BS, Burnham JM, Leonard MB (2008) Interpretation of biomarkers of bone metabolism in children: impact of growth velocity and body size in healthy children and chronic disease. J Pediatr 153:484–490
Rauch F (2006) Watching bone cells at work: what we can see from bone biopsies. Pediatr Nephrol 21:457–462
Compston JE, Ayers AB, Horton LW, Tighe JR, Creamer B (1978) Osteomalacia after small-intestinal resection. Lancet 1:9–12
Hessov I, Mosekilde L, Melsen F, Fasth S, Hulten L, Lund B, Sorensen OH (1984) Osteopenia with normal vitamin D metabolites after small-bowel resection for Crohn’s disease. Scand J Gastroenterol 19:691–696
Croucher PI, Vedi S, Motley RJ, Garrahan NJ, Stanton MR, Compston JE (1993) Reduced bone formation in patients with osteoporosis associated with inflammatory bowel disease. Osteoporos Int 3:236–241
Hyams J, Markowitz J, Otley A, Rosh J, Mack D, Bousvaros A, Kugathasan S, Pfefferkorn M, Tolia V, Evans J, Treem W, Wyllie R, Rothbaum R, del Rosario J, Katz A, Mezoff A, Oliva-Hemker M, Lerer T, Griffiths A (2005) Evaluation of the pediatric Crohn disease activity index: a prospective multicenter experience. J Pediatr Gastroenterol Nutr 41:416–421
Turner D, Otley AR, Mack D, Hyams J, de Bruijne J, Uusoue K, Walters TD, Zachos M, Mamula P, Beaton DE, Steinhart AH, Griffiths AM (2007) Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology 133:423–432
Marshall WA, Tanner JM (1969) Variations in pattern of pubertal changes in girls. Arch Dis Child 44:291–303
Marshall WA, Tanner JM (1970) Variations in the pattern of pubertal changes in boys. Arch Dis Child 45:13–23
van Wieringen JC (1971) Growth diagrams. Netherlands Wooplter-Noorhoff, Groningen
Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL (2002) Centers for disease control and prevention 2000 growth charts for the United States: improvements to the 1977 national center for health statistics version. Pediatrics 109:45–60
Bollen AM, Eyre DR (1994) Bone resorption rates in children monitored by the urinary assay of collagen type I cross-linked peptides. Bone 15:31–34
Greulich WW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist, 2nd edn. Stanford University Press, Palo Alto
Kroger H, Kotaniemi A, Vainio P, Alhava E (1992) Bone densitometry of the spine and femur in children by dual-energy X-ray absorptiometry. Bone Miner 17:75–85
van der Sluis IM, de Ridder MA, Boot AM, Krenning EP, de Muinck Keizer-Schrama SM (2002) Reference data for bone density and body composition measured with dual energy X ray absorptiometry in white children and young adults. Arch Dis Child 87:341–347 discussion 341–347
Hogler W, Briody J, Woodhead HJ, Chan A, Cowell CT (2003) Importance of lean mass in the interpretation of total body densitometry in children and adolescents. J Pediatr 143:81–88
Glorieux FH, Travers R, Taylor A, Bowen JR, Rauch F, Norman M, Parfitt AM (2000) Normative data for iliac bone histomorphometry in growing children. Bone 26:103–109
Parfitt AM, Drezner MK, Glorieux FH, Kanis JA, Malluche H, Meunier PJ, Ott SM, Recker RR (1987) Bone histomorphometry: standardization of nomenclature, symbols, and units. Report of the ASBMR histomorphometry nomenclature committee. J Bone Miner Res 2:595–610
Institute of Medicine (1997) Dietary reference intakes for calcium, phosphorus, magnesium, Vitamin D, fluoride. National Academy Press, Washington, D.C
Terpstra L, Rauch F, Plotkin H, Travers R, Glorieux FH (2002) Bone mineralization in polyostotic fibrous dysplasia: histomorphometric analysis. J Bone Miner Res 17:1949–1953
Burnham JM, Shults J, Semeao E, Foster B, Zemel BS, Stallings VA, Leonard MB (2004) Whole body BMC in pediatric Crohn disease: independent effects of altered growth, maturation, and body composition. J Bone Miner Res 19:1961–1968
Burnham JM, Shults J, Semeao E, Foster BJ, Zemel BS, Stallings VA, Leonard MB (2005) Body-composition alterations consistent with cachexia in children and young adults with Crohn disease. Am J Clin Nutr 82:413–420
Binkley TL, Specker BL (2008) Muscle–bone relationships in the lower leg of healthy pre-pubertal females and males. J Musculoskelet Neuronal Interact 8:239–243
Lin CL, Moniz C, Chambers TJ, Chow JW (1996) Colitis causes bone loss in rats through suppression of bone formation. Gastroenterology 111:1263–1271
Hamdani G, Gabet Y, Rachmilewitz D, Karmeli F, Bab I, Dresner-Pollak R (2008) Dextran sodium sulfate-induced colitis causes rapid bone loss in mice. Bone 43:945–950
Parfitt AM (1993) Morphometry of bone resorption: introduction and overview. Bone 14:435–441
Semeao EJ, Stallings VA, Peck SN, Piccoli DA (1997) Vertebral compression fractures in pediatric patients with Crohn’s disease. Gastroenterology 112:1710–1713
Klaus J, Armbrecht G, Steinkamp M, Bruckel J, Rieber A, Adler G, Reinshagen M, Felsenberg D, von Tirpitz C (2002) High prevalence of osteoporotic vertebral fractures in patients with Crohn’s disease. Gut 51:654–658
Stockbrugger RW, Schoon EJ, Bollani S, Mills PR, Israeli E, Landgraf L, Felsenberg D, Ljunghall S, Nygard G, Persson T, Graffner H, Bianchi Porro G, Ferguson A (2002) Discordance between the degree of osteopenia and the prevalence of spontaneous vertebral fractures in Crohn’s disease. Aliment Pharmacol Ther 16:1519–1527