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P280 Prediction factors for low bone mineral density in children with Crohn’s disease

N. Ronel1, A. Guz-Mark2, A. Assa2, R. Lev Zion1, E. Shteyer1, D. Strich1, D. Turner1, O. Ledder*1

1Shaare Zedek Medical Center, Jerusalem, Israel, 2Schneider Medical Center, Petach Tikva, Israel

Background

Since bone mass is almost exclusively accrued during childhood, early recognition and treatment of osteopenia is paramount in paediatric Crohn’s disease (CD). We aimed to identify variables predictive of moderate–severe osteopenia to guide screening to those who most need it.

Methods

Retrospective review of medical records of children (2–18 years) diagnosed with CD at Shaare Zedek and Schneider medical centres. Demographic, anthropomorphic, clinical, biochemical, radiological, and endoscopic features at diagnosis were recorded along with bone mineral density (BMD) z-scores based on whole-body dual-energy X-ray absorptiometry (DEXA) scans corrected to gender and height.

Results

In total, 155 children were included (mean age 13 ± 3 years, 91 (59%) males, mean body mass index (BMI) 17.2 ± 2.9, median paediatric Crohn’s disease activity index (PCDAI) 25 (IQR 17.5–37.5). Eighteen children (12%) had stricturing or penetrating disease, 36 (23%) had perianal and 59 (38%) had growth delay. Mild osteopenia (z-score −1 to −2) was observed in 36 (23%) children and moderate–severe (z-score <−2) in 53 (34%). Based on unadjusted BMD z-scores, children with moderate–severe osteopenia had a higher mean PCDAI score (32 ± 16 vs. 27 ± 13, p = 0.036), platelet count (432 × 103/μl ± 119 vs. 400 ± 100, p = 0.013), a higher incidence of growth delay (56% vs. 13%, p < 0.001), lower mean BMI (16.3 ± 2.6 vs. 18.4 ± 3.0, p = 0.001) and lower serum albumin (3.5 g/dl ± 0.7 vs. 3.8 ± 0.4, p = 0.019) than those with normal BMD (z-score > −1). However, when BMD z-scores were corrected for height the only significant association was with PCDAI (34 ± 15 vs. 24 ± 16, p = 0.027) and BMI (16 ± 2 vs. 19 ± 2, p < 0.001). There was no association between the presence of osteopenia and disease extent or location, age or presence of perianal disease.

Conclusion

Osteopenia is a frequent finding in paediatric CD and is associated with several variables at disease onset. Appropriate referral practices and early identification of patients with moderate–severe osteopenia is important, and accurate prediction of patients may assist timely intervention.