‘a Clinical Report on Skeletal Health of Children and Adolescents with Inflammatory Bowel Disease”

Objectives—Current evidence, albeit sparse, points to suboptimal bone health in children and adolescents with inflammatory bowel disease (IBD) when compared to healthy peers. In this clinical report we aimed to: a) review the current literature regarding the pathogenesis of suboptimal bone health and its clinical consequences and long term outcome in children with IBD, b) provide recommendations regarding screening and monitoring bone health, c) review the evidence on available measures and agents to prevent compromise and improve bone health d) summarize the gaps in knowledge and point to research directions. Methods—Six experts in pediatric bone health and IBD reviewed the available literature specific to their area of expertise. Evidence was rated using an adjusted evidence rating system. Results—The mechanism of suboptimal bone health in children with IBD lays in reduced bone formation and resorption. This could lead to reduced bone mineral density (BMD), which may predispose to fractures and suboptimal peak bone mass. Factors contributing to this derangement are: inflammation, delayed growth and puberty, lean mass deficits, and use of glucocorticoids. Improvement in linear growth and repletion of lean mass may help improve bone health in children with IBD. The role of vitamin D, calcium, exercise, biologics and bisphosphonates is under investigation. Conclusions—We recommend: screening and monitoring BMD in children with IBD and certain identified risk factors, control of inflammation with steroid-sparing techniques, nutritional DISCLOSURES Dr Pappa: Nothing to disclose Dr Thayu: Nothing to disclose Dr Sylvester: Nothing to disclose Dr Leonard: Nothing to disclose Dr Zemel: Nothing to disclose Dr Gordon: Co-director, Clinical Investigation Training Program (Harvard/MIT with Pfizer/Merck) Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author Manuscript J Pediatr Gastroenterol Nutr. Author manuscript; available in PMC 2012 July 1. Published in final edited form as: J Pediatr Gastroenterol Nutr. 2011 July ; 53(1): 11–25. doi:10.1097/MPG.0b013e31821988a3. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript support in children with growth delays and/or lean mass deficits, optimization of vitamin D status, and weight bearing physical activity. Gaps in knowledge are numerous and require investigation. PART A. SCREENING AND MONITORING BONE HEALTH IN CHILDREN AND ADOLESCENTS WITH IBD