HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Accepted manuscript (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Vihinen, M. Articles by Raivio, T. PubMed PubMed Citation Articles by Vihinen, M. Articles by Raivio, T.

Bone turnover and metabolism in paediatric patients with inflammatory bowel disease treated with systemic glucocorticoids

M Vihinen, Hospital for Children and Adolescents, University of Helsinki, Helsinki, 00029 HUCH, Finland
K Kolho, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
M Ashorn, Department of Paediatrics, University of Tampere, Tampere, Finland
M Verkasalo, Helsinki, United Kingdom
T Raivio, Helsinki, Finland

Correspondence: Marianne Vihinen, Email: marianne.vihinen{at}helsinki.fi

Abstract

Objective: We investigated circulating markers of bone turnover before and during systemic glucocorticoid treatment in paediatric patients with inflammatory bowel disease (IBD).

Methods: 22 children (mean age, 12.3 yrs) with IBD necessitating peroral steroid therapy were studied, with special reference to bone formation and resorption markers amino-terminal type I collagen propeptide (PINP) and carboxyterminal telopeptide of type I collagen (ICTP), respectively. In addition, growth hormone -related insulin-like growth factor I (IGF-I) and sex hormone binding protein (SHBG) were measured. Bone markers were analyzed at the initiation of the glucocorticoid treatment, at 2 and 5 weeks thereafter and at 1 month following the withdrawal of the steroid. Control group comprised 22 IBD patients in remission.

Results: Already before glucocorticoid treatment serum PINP and IGF-1 were lower in children with active IBD as compared to control children with IBD in remission (median PINP 271 vs. 535 ug/l, P<0.05; IGF-1 23 vs. 29 nmol/l, P<0.05). After 2 weeks of glucocorticoid treatment serum PINP levels had declined further, from 271 ug/l to 163 ug/l (P<0.001), serum ICTP from 14.2 ug/l to 9.6 ug/l (P<0.001), and SHBG from 54 to 35 nmol/l (P<0.001), respectively. In contrast, serum IGF-I increased from 23 to 37 nmol/l (P<0.001). One month after the withdrawal of the glucocorticoid, all bone markers restored to levels similar to the controls.

Conclusions: Bone formation in children with active IBD appears compromised and systemic glucocorticoid treatment further suppresses bone turnover. After the cessation of the glucocorticoid the bone markers show immediate improvement.