Compromised peak bone mass in patients with inflammatory bowel disease--a prospective study

J Pediatr. 2014 Jun;164(6):1436-43.e1. doi: 10.1016/j.jpeds.2014.01.073. Epub 2014 Mar 17.


Objective: To evaluate peak bone mass attainment in children and adolescents with inflammatory bowel disease and to identify risk factors for suboptimal bone mass attainment.

Study design: We conducted a prospective follow-up study of 47 children and adolescents (24 males) with ulcerative colitis (n = 30) or Crohn's disease (n = 17). They were assessed for lumbar spine areal bone mineral density (aBMD) and for height-adjusted whole body less head bone mineral content (BMC); the values were corrected for bone age.

Results: Altogether, 73% of the patients had completed pubertal development after the median follow-up time of over 5 years. Despite clinical inactivity of the disease in 70% of the patients at the follow-up visit, BMD or BMC Z-scores improved in none of the measurement sites. Lumbar spine aBMD Z-scores (mean difference [95% CI], -0.47 [-0.92 to -0.03]; P = .04) and whole body less head BMC height- and bone age-adjusted Z-scores (-0.52 [-1.01 to -0.02]; P = .04) decreased in patients who were pubertal at baseline and completed their pubertal development during the follow-up. Postpubertal patients had lower aBMD and BMC Z-scores in comparison with prepubertal and pubertal patients. Low lumbar spine aBMD (Z-score < -1.0) was associated with completed pubertal development, underweight, and greater lifetime cumulative weight-adjusted prednisolone dose. Vertebral fractures were detected in 3 patients (6%). One-fourth of the patients had insufficient serum 25-hydroxyvitamin D concentrations (<50 nmol/L).

Conclusions: The longitudinal follow-up over the pubertal years shows that inflammatory bowel disease poses a significant threat for bone health. The suboptimal peak bone mass attainment may have life-long consequences.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon / methods
  • Adolescent
  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use
  • Age Distribution
  • Body Height
  • Bone Density / physiology*
  • Child
  • Cohort Studies
  • Colitis, Ulcerative / diagnosis
  • Colitis, Ulcerative / epidemiology*
  • Comorbidity
  • Crohn Disease / diagnosis
  • Crohn Disease / drug therapy
  • Crohn Disease / epidemiology*
  • Female
  • Follow-Up Studies
  • Fractures, Spontaneous / diagnostic imaging
  • Fractures, Spontaneous / epidemiology
  • Humans
  • Incidence
  • Inflammatory Bowel Diseases / diagnosis
  • Inflammatory Bowel Diseases / drug therapy
  • Inflammatory Bowel Diseases / epidemiology
  • Longitudinal Studies
  • Lumbar Vertebrae / diagnostic imaging
  • Male
  • Osteoporosis / diagnostic imaging
  • Osteoporosis / drug therapy
  • Osteoporosis / epidemiology*
  • Puberty / physiology
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Vitamin D / analogs & derivatives
  • Vitamin D / therapeutic use
  • Young Adult


  • Adrenal Cortex Hormones
  • Vitamin D
  • 25-hydroxyvitamin D