Pediatric Crohn Disease Linked to Low Bone Mineral Density

Low bone mineral density (BMD) was found to be a common complication of new-onset, mild to moderate pediatric Crohn disease (CD), according to the results of a study published in Journal of Pediatric Gastroenterology and Nutrition.

Children with CD are known to be at increased risk for impaired BMD. Although exclusive enteral nutrition (EEN) avoids the deleterious effects of corticosteroids and promotes bone growth, current data on the effects of EEN on bone health in patients with pediatric CD are lacking. A team of investigators therefore conducted a multicenter prospective study to evaluate the effects of nutritional therapy on bone health in this patient cohort.

The researchers recruited children aged 4 to 18 with mild to moderately active inflammatory CD (Pediatric CD Activity Index 10-40 points).

Participants were randomized to either 6 weeks of  EEN followed by 6 weeks of 25% partial enteral nutrition (PEN) with free diet (Group 1) or 6 weeks of 50% PEN with a CD exclusion diet followed by 6 weeks of 25% PEN + 75% exclusion diet (Group 2).

Serum C-Propeptide of Type I Procollagen (CICP) and type I Collagen N-Telopeptide (NTX) were used to measure bone formation and resorption at baseline, week 12, and week 24, respectively. Dual energy x-ray absorptiometry (DXA) was used to measure BMD at baseline and at week 24.

The mean age of patients was 13.7+2.9 years and median disease duration was approximately 1 (interquartile range [IQR], 0-2) month.

Paired analysis of individual patients revealed that median CICP from baseline improved from 130 ng/mL (IQR, 106-189) to 223 ng/mL (IQR, 143-258) at week 12 and 193ng/mL (IQR, 143-252) at week 24 (P=.016 for both, n=29 children). Median NTX remained unchanged from baseline (P=.45) to week 24 (P=.45).

DXA scans performed at diagnosis were available for 36 children; 81% and 33% had z-scores of ≤1 and ≤2, respectively. Similarly, DXA z-scores did not improve from baseline (adjusted total body less head [TBLH] BMD, -1.62+0.87) to week 24 (TBLH BMD, -1.76+0.75; P=.30) with either scan.  

This study is not without limitations. The original study was statistically powered for the clinical endpoint of tolerance to the CD exclusion diet. Thus, bone analysis may have been underpowered. Additionally, ability to perform reliable subset analysis was limited due to a lack of available DXA scans and biomarker tests in the original patient cohort.

These data indicate low BMD is common, even among patients with mild to moderate pediatric CD. EEN improved CICP, a bone formation biomarker, but not BMD. Furthermore, children who achieved clinical remission were found to avoid the decrease in BMD seen in those who did not.   

Disclosure: Multiple authors declared industry affiliations. Please refer to the original article for a full list of authors disclosures.

Reference

Lev-Tzion R, Ben-Moshe T, Abitbol G, et al. The effect of nutritional therapy on bone mineral density and bone metabolism in pediatric Crohn’s disease. J Pediatric Gastroenterol Nutr. Published online February 9, 2021. doi:10.1097/MPG.0000000000003073