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Skeletal status assessed by quantitative ultrasound and dual-energy X-ray absorptiometry in children with inflammatory bowel disease: A 2-year prospective study. Clin Res Hepatol Gastroenterol 2020; 44:768-777. [PMID: 31631055 DOI: 10.1016/j.clinre.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE To assess the bone status in children with inflammatory bowel diseases (IBD) using quantitative ultrasound (QUS) measurement and dual-energy X-ray absorptiometry (DXA) at baseline and after two years of adequate treatment of the IBD and bone protection medication. METHODS Sixteen children (six boys) with IBD, aged 13.4±2.4 years, were examined at baseline and two years later. DXA was used to asses bone mineral density (BMD) and reference data were provided by the device's manufacturer (Hologic Explorer). QUS measurements were performed in patients and controls - 48 healthy children. RESULTS Mean Z-scores for TB- and s-BMD were significantly below zero for both, baseline and follow-up (-2.61±0.99 and -2.48±0.88 for TB, and -1.83±1.33 and -1.61±1.19 for s-BMD, respectively), and did not differ significantly, as well as mean Ad-SoS Z-score. The changes in time of TB Z-score and body weight Z-score correlated positively (r=0.63; P<0.01). The QUS results did not differ between patients and controls. There was a negative correlation between the baseline nutritional status and the activity of the disease, as well as of the number of flares before the enrolment and Ad-SoS Z-score. CONCLUSIONS BMD was found to be lowered both at baseline and follow-up. No further deterioration was observed during 2-year follow-up. Proper treatment, defined as treatment following ECCO Guidelines, may allow to keep a similar trend in the development of bone tissue as in healthy children. The bone properties assessed by QUS method did not differ between patients and controls. QUS at hand phalanges appears not to be proper diagnostic tool in IBD children.
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Franceschi R, Longhi S, Cauvin V, Fassio A, Gallo G, Lupi F, Reinstadler P, Fanolla A, Gatti D, Radetti G. Bone Geometry, Quality, and Bone Markers in Children with Type 1 Diabetes Mellitus. Calcif Tissue Int 2018; 102:657-665. [PMID: 29290007 DOI: 10.1007/s00223-017-0381-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/27/2017] [Indexed: 12/16/2022]
Abstract
Adults with Type 1 diabetes mellitus show a high risk of bone fracture, probably as a consequence of a decreased bone mass and microarchitectural bone alterations. The aim of the study was to investigate the potential negative effects of type 1 diabetes on bone geometry, quality, and bone markers in a group of children and adolescents. 96 children, mean age 10.5 ± 3.1 years, agreed to participate to the study. Bone geometry was evaluated on digitalized X-rays at the level of the 2nd metacarpal bone. The following parameters were investigated and expressed as SDS: outer diameter (D), inner diameter (d), cortical area (CA), and medullary area (MA). Bone strength was evaluated as Bending Breaking Resistance Index (BBRI) from the geometric data. Bone turnover markers (PINP, CTX-I, and BAP), sclerostin, Dkk-1, PTH, and 25OH-Vitamin D were also assessed. A group of healthy 40 subjects of normal body weight and height served as controls for the bone markers. D (- 0.99 ± 0.98), d (- 0.41 ± 0.88), CA (- 0.85 ± 0.78), and MA (- 0.46 ± 0.78) were all significantly smaller than in controls (p < 0.01). BBRI was significantly lower (- 2.61 ± 2.18; p < 0.0001). PTH, PINP, and BAP were higher in the diabetic children. Multiple regression analysis showed that CA and D were influenced by insulin/Kg/day and by BMI, while d was influenced by PINP only. Type 1 diabetic children show smaller and weaker bones. The increased bone turnover could play a key role since it might amplify the deficit in bone strength associated with the inadequate osteoblastic activity caused by the disease itself.
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Affiliation(s)
| | - Silvia Longhi
- Department of Pediatrics, General Hospital Bolzano, Bolzano, Italy
| | - Vittoria Cauvin
- Department of Pediatrics, Santa Chiara Hospital Trento, Trento, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Giuseppe Gallo
- Department of Pediatrics, Santa Chiara Hospital Trento, Trento, Italy
| | - Fiorenzo Lupi
- Department of Pediatrics, General Hospital Bolzano, Bolzano, Italy
| | | | - Antonio Fanolla
- Department of Biostatistics, Regional Hospital Bolzano, Bolzano, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Giorgio Radetti
- Department of Pediatrics, General Hospital Bolzano, Bolzano, Italy.
- Marienklinik, Via Claudia De Medici, 2, 39100, Bolzano, Italy.
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Bąk-Drabik K, Adamczyk P, Chobot A, Kwiecień J, Pluskiewicz W. Bone status assessed by quantitative ultrasound in children with inflammatory bowel disease: a comparison with DXA. Expert Rev Gastroenterol Hepatol 2016; 10:1305-1312. [PMID: 27677691 DOI: 10.1080/17474124.2016.1242410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND To determine the bone status in children with inflammatory bowel diseases (IBD) using quantitative ultrasound (QUS) measurement at hand phalanges and compare the obtained results with dual-energy X-ray absorptiometry (DXA). METHODS Fifty-one children with IBD underwent DXA and QUS measurements at hand phalanges in the year 2013. The control group for the QUS consisted of 460 children. Reference data for DXA comes from Hologic Explorer. RESULTS QUS measurements did not differ significantly between IBD patients and healthy controls. There was no difference between UC and CD subjects. DXA measurements in patients with IBD were lower than in the healthy population. Tanner stage and nutritional status correlated with bone status contrary to steroids therapy. CONCLUSION Low bone mineral density often complicates IBD in children. QUS is not an appropriate method for the assessment of bone status in children. Nutritional status seems to have a greater impact on bone status than corticosteroids therapy.
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Affiliation(s)
- Katarzyna Bąk-Drabik
- a Department of Pediatrics, School of Medicine with the Division of Dentistry in Zabrze , Medical University of Silesia , Katowice , Poland
| | - Piotr Adamczyk
- a Department of Pediatrics, School of Medicine with the Division of Dentistry in Zabrze , Medical University of Silesia , Katowice , Poland
| | - Agata Chobot
- b Department of Pediatrics , Public Clinical Hospital No. 1 , Zabrze , Poland
| | - Jarosław Kwiecień
- a Department of Pediatrics, School of Medicine with the Division of Dentistry in Zabrze , Medical University of Silesia , Katowice , Poland
| | - Wojciech Pluskiewicz
- c Department of Internal Medicine, Diabetology and Nephrology, Metabolic Bone Diseases Unit, School of Medicine with the Division of Dentistry in Zabrze , Medical University of Silesia , Katowice , Poland
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Hough FS, Pierroz DD, Cooper C, Ferrari SL. MECHANISMS IN ENDOCRINOLOGY: Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus. Eur J Endocrinol 2016; 174:R127-38. [PMID: 26537861 DOI: 10.1530/eje-15-0820] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/04/2015] [Indexed: 12/20/2022]
Abstract
Subjects with type 1 diabetes mellitus (T1DM) have decreased bone mineral density and an up to sixfold increase in fracture risk. Yet bone fragility is not commonly regarded as another unique complication of diabetes. Both animals with experimentally induced insulin deficiency syndromes and patients with T1DM have impaired osteoblastic bone formation, with or without increased bone resorption. Insulin/IGF1 deficiency appears to be a major pathogenetic mechanism involved, along with glucose toxicity, marrow adiposity, inflammation, adipokine and other metabolic alterations that may all play a role on altering bone turnover. In turn, increasing physical activity in children with diabetes as well as good glycaemic control appears to provide some improvement of bone parameters, although robust clinical studies are still lacking. In this context, the role of osteoporosis drugs remains unknown.
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Affiliation(s)
- F S Hough
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South AfricaInternational Osteoporosis Foundation (IOF)Nyon, SwitzerlandMRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UKNIHR Musculoskeletal Biomedical Research UnitNuffield Department of Orthopaedics, University of Oxford, Oxford, UKDivision of Bone DiseasesDepartment of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - D D Pierroz
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South AfricaInternational Osteoporosis Foundation (IOF)Nyon, SwitzerlandMRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UKNIHR Musculoskeletal Biomedical Research UnitNuffield Department of Orthopaedics, University of Oxford, Oxford, UKDivision of Bone DiseasesDepartment of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - C Cooper
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South AfricaInternational Osteoporosis Foundation (IOF)Nyon, SwitzerlandMRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UKNIHR Musculoskeletal Biomedical Research UnitNuffield Department of Orthopaedics, University of Oxford, Oxford, UKDivision of Bone DiseasesDepartment of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South AfricaInternational Osteoporosis Foundation (IOF)Nyon, SwitzerlandMRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UKNIHR Musculoskeletal Biomedical Research UnitNuffield Department of Orthopaedics, University of Oxford, Oxford, UKDivision of Bone DiseasesDepartment of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - S L Ferrari
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South AfricaInternational Osteoporosis Foundation (IOF)Nyon, SwitzerlandMRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UKNIHR Musculoskeletal Biomedical Research UnitNuffield Department of Orthopaedics, University of Oxford, Oxford, UKDivision of Bone DiseasesDepartment of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
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