engleski

Bone markers in chronic inflammatory bowel disease in children and adolescents.

Chronic inflammatory bowel diseases in children may cause impairment of bone metabolism and increased risk of osteoporosis. The aim of this study was assessment of bone metabolism in 47 patients (19 boys, 28 girls, age 13.72 +/-2.77, range 7-20 years) with Crohn&#8217; s disease (30), ulcerative colitis (11) and non-determined colitis (6). Measurements comprised 25-OH D, bone markers - osteocalcin, procollagen 1 propeptide (P1CP), collagen 1 telopeptide also in serum and urine (crosslaps) ; and lumbar spine densitometry. Follow-up in 27 patients included measurement of bone markers every 6 months and densitometry after 12 months. No difference existed between sexes, diagnoses or z-scores. Bone markers were on average increased as compared to adult values. In girls, greater variation with higher values at age 10-12 and decrement therafter was observed. In boys higher values were found at 12-14 years and decrease at age 16 years. Initial 25-OH D was decreased in most patients (<50 nmol/L in 67%, <80 nmol/L in 88%). Z-scores were mostly greater than &#8211; 2.5, except in 3 patients. At the start of the study negative correlation with age was found for 25-OH D (p<0.03), telopeptide in serum (p<0.004) and urine (p<0.001). Positive correlation existed between bone markers. In the follow-up only 25-OH D showed significant increment (n=21, p<0.009) which coincided with sampling in Spring and Summer. Patient monitoring by densitometry and bone markers did not reveal a trend related to clinical outcome (improvemet, unchanged, deterioration) or was affected by age. These results show that in children with chronic inflammatory bowel disease vitamin D deficiency is the most prominent finding. Measurement of bone markers demonstrated skeletal growth and high bone turnover at puberty, with later cessation toward adult values. Skeletal integrity as assessed by densitometry and bone markers was not compromised. Continuation of patient monitoring might reveal bone metabolism variations related to disease and treatment.

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