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- Title
Improvements in Bone Density and Structure during Anti-TNF-α Therapy in Pediatric Crohn's Disease.
- Authors
Griffin, Lindsay M; Thayu, Meena; Baldassano, Robert N; DeBoer, Mark D; Zemel, Babette S; Denburg, Michelle R; Denson, Lee A; Shults, Justine; Herskovitz, Rita; Long, Jin; Leonard, Mary B
- Abstract
<bold>Context: </bold>Pediatric Crohn's Disease (CD) is associated with deficits in trabecular bone mineral density (BMD) and cortical structure, potentially related to TNF-α effects to decrease bone formation and promote bone resorption.<bold>Objective: </bold>This study aimed to examine changes in bone density and structure in children and adolescents with CD following initiation of anti-TNF-α therapy.<bold>Design and Participants: </bold>Participants (n = 74; age 5-21 years) with CD completed a 12-month prospective cohort study.<bold>Main Outcome Measures: </bold>Tibia peripheral quantitative computed tomography scans were obtained at initiation of anti-TNF-α therapy and 12 months later. Musculoskeletal outcomes were expressed as sex-and race-specific z scores relative to age, based on >650 reference participants.<bold>Results: </bold>At baseline, CD participants had lower height, trabecular BMD, cortical area (due to smaller periosteal and larger endocortical circumferences), and muscle area z scores, compared with reference participants (all P < .01). Pediatric CD activity index decreased during the 10-week induction (P < .001), in association with subsequent gains in height, trabecular BMD, cortical area (due to recovery of endocortical bone), and muscle area z scores over 12 months (height P < .05; others P < .001). Bone-specific alkaline phosphatase levels, a biomarker of bone formation, increased a median of 75% (P < .001) during induction with associated 12-month improvements in trabecular BMD and cortical area z scores (both P < .001). Younger age was associated with greater increases in trabecular BMD z scores (P < .001) and greater linear growth with greater recovery of cortical area (P < .001).<bold>Conclusions: </bold>Anti-TNF-α therapy was associated with improvements in trabecular BMD and cortical structure. Improvements were greater in younger and growing participants, suggesting a window of opportunity for treatment of bone deficits.
- Publication
Journal of Clinical Endocrinology & Metabolism, 2015, Vol 100, Issue 7, p2630
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2014-4152