Changes in trabecular bone density in incident pediatric Crohn's disease

A comparison of imaging methods

A. Tsampalieros, Meghan Berkenstock, B. S. Zemel, L. Griffin, J. Shults, J. M. Burnham, R. N. Baldassano, M. B. Leonard

Research output: Contribution to journalArticle

Abstract

This study of changes in dual energy x-ray absorptiometry (DXA) spine BMD following diagnosis and treatment for childhood Crohn's disease demonstrated that changes in conventional posteroanterior BMD results were confounded by impaired growth, and suggested that lateral spine measurements and strategies to estimate volumetric BMD were more sensitive to disease and treatment effects. Introduction: We previously reported significant increases in peripheral quantitative CT (pQCT) measures of trabecular volumetric bone mineral density (vBMD) following diagnosis and treatment of pediatric Crohn's disease (CD). The objective of this study was to compare pQCT trabecular vBMD and three DXA measures of spine BMD in this cohort: (1) conventional posteroanterior BMD (PA-BMD), (2) PA-BMD adjusted for height Z (PA-BMDHtZ), and (3) width-adjusted volumetric BMD (WA-BMD) estimated from PA and lateral scans. Methods: Spine DXA [lumbar (L1-4) for posteroanterior and L3 for lateral] and tibia pQCT scans were obtained in 65 CD subjects (ages 7-18 years) at diagnosis and 12 months later. BMD results were converted to sex, race, and age-specific Z-scores based on reference data in >650 children (ages 5-21 years). Multivariable linear regression models identified factors associated with BMD Z-scores. Results: At CD diagnosis, all BMD Z-scores were lower compared with the reference children (all p values <0.01). The pQCT vBMD Z-scores (-1.46∈±∈1.30) were lower compared with DXA PA-BMD (-0.75∈±∈0.98), PA-BMDHtZ (-0. 53∈±∈0.87), and WA-BMD (-0.61∈±∈1.10) among CD participants. Only PA-BMD Z-scores were correlated with height Z-scores at baseline (R∈=∈0.47, p∈<∈0.0001). pQCT and WA-BMD Z-scores increased significantly over 12 months to -1.04∈±∈1.26 and -0.20∈±∈1.14, respectively. Changes in all four BMD Z-scores were positively associated with changes in height Z-scores (p∈<∈0. 05). Glucocorticoid doses were inversely associated with changes in WA-BMD (p∈<∈0.01) only. Conclusions: Conventional and height Z-score-adjusted PA DXA methods did not demonstrate the significant increases in trabecular vBMD noted on pQCT and WA-BMD scans. WA-BMD captured glucocorticoid effects, potentially due to isolation of the vertebral body on the lateral projection. Future studies are needed to identify the BMD measure that provides greatest fracture discrimination in CD.

Original languageEnglish (US)
Pages (from-to)1875-1883
Number of pages9
JournalOsteoporosis International
Volume25
Issue number7
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Crohn Disease
Bone Density
X-Rays
Spine
Cone-Beam Computed Tomography
Glucocorticoids
Linear Models
Tibia
Therapeutics
Cancellous Bone
Pediatric Crohn's disease
Growth

Keywords

  • Bone disease
  • Crohn's disease
  • DXA
  • Glucocorticoids
  • Growth
  • Inflammation

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Changes in trabecular bone density in incident pediatric Crohn's disease : A comparison of imaging methods. / Tsampalieros, A.; Berkenstock, Meghan; Zemel, B. S.; Griffin, L.; Shults, J.; Burnham, J. M.; Baldassano, R. N.; Leonard, M. B.

In: Osteoporosis International, Vol. 25, No. 7, 2014, p. 1875-1883.

Research output: Contribution to journalArticle

Tsampalieros, A, Berkenstock, M, Zemel, BS, Griffin, L, Shults, J, Burnham, JM, Baldassano, RN & Leonard, MB 2014, 'Changes in trabecular bone density in incident pediatric Crohn's disease: A comparison of imaging methods', Osteoporosis International, vol. 25, no. 7, pp. 1875-1883. https://doi.org/10.1007/s00198-014-2701-x
Tsampalieros, A. ; Berkenstock, Meghan ; Zemel, B. S. ; Griffin, L. ; Shults, J. ; Burnham, J. M. ; Baldassano, R. N. ; Leonard, M. B. / Changes in trabecular bone density in incident pediatric Crohn's disease : A comparison of imaging methods. In: Osteoporosis International. 2014 ; Vol. 25, No. 7. pp. 1875-1883.
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T1 - Changes in trabecular bone density in incident pediatric Crohn's disease

T2 - A comparison of imaging methods

AU - Tsampalieros, A.

AU - Berkenstock, Meghan

AU - Zemel, B. S.

AU - Griffin, L.

AU - Shults, J.

AU - Burnham, J. M.

AU - Baldassano, R. N.

AU - Leonard, M. B.

PY - 2014

Y1 - 2014

N2 - This study of changes in dual energy x-ray absorptiometry (DXA) spine BMD following diagnosis and treatment for childhood Crohn's disease demonstrated that changes in conventional posteroanterior BMD results were confounded by impaired growth, and suggested that lateral spine measurements and strategies to estimate volumetric BMD were more sensitive to disease and treatment effects. Introduction: We previously reported significant increases in peripheral quantitative CT (pQCT) measures of trabecular volumetric bone mineral density (vBMD) following diagnosis and treatment of pediatric Crohn's disease (CD). The objective of this study was to compare pQCT trabecular vBMD and three DXA measures of spine BMD in this cohort: (1) conventional posteroanterior BMD (PA-BMD), (2) PA-BMD adjusted for height Z (PA-BMDHtZ), and (3) width-adjusted volumetric BMD (WA-BMD) estimated from PA and lateral scans. Methods: Spine DXA [lumbar (L1-4) for posteroanterior and L3 for lateral] and tibia pQCT scans were obtained in 65 CD subjects (ages 7-18 years) at diagnosis and 12 months later. BMD results were converted to sex, race, and age-specific Z-scores based on reference data in >650 children (ages 5-21 years). Multivariable linear regression models identified factors associated with BMD Z-scores. Results: At CD diagnosis, all BMD Z-scores were lower compared with the reference children (all p values <0.01). The pQCT vBMD Z-scores (-1.46∈±∈1.30) were lower compared with DXA PA-BMD (-0.75∈±∈0.98), PA-BMDHtZ (-0. 53∈±∈0.87), and WA-BMD (-0.61∈±∈1.10) among CD participants. Only PA-BMD Z-scores were correlated with height Z-scores at baseline (R∈=∈0.47, p∈<∈0.0001). pQCT and WA-BMD Z-scores increased significantly over 12 months to -1.04∈±∈1.26 and -0.20∈±∈1.14, respectively. Changes in all four BMD Z-scores were positively associated with changes in height Z-scores (p∈<∈0. 05). Glucocorticoid doses were inversely associated with changes in WA-BMD (p∈<∈0.01) only. Conclusions: Conventional and height Z-score-adjusted PA DXA methods did not demonstrate the significant increases in trabecular vBMD noted on pQCT and WA-BMD scans. WA-BMD captured glucocorticoid effects, potentially due to isolation of the vertebral body on the lateral projection. Future studies are needed to identify the BMD measure that provides greatest fracture discrimination in CD.

AB - This study of changes in dual energy x-ray absorptiometry (DXA) spine BMD following diagnosis and treatment for childhood Crohn's disease demonstrated that changes in conventional posteroanterior BMD results were confounded by impaired growth, and suggested that lateral spine measurements and strategies to estimate volumetric BMD were more sensitive to disease and treatment effects. Introduction: We previously reported significant increases in peripheral quantitative CT (pQCT) measures of trabecular volumetric bone mineral density (vBMD) following diagnosis and treatment of pediatric Crohn's disease (CD). The objective of this study was to compare pQCT trabecular vBMD and three DXA measures of spine BMD in this cohort: (1) conventional posteroanterior BMD (PA-BMD), (2) PA-BMD adjusted for height Z (PA-BMDHtZ), and (3) width-adjusted volumetric BMD (WA-BMD) estimated from PA and lateral scans. Methods: Spine DXA [lumbar (L1-4) for posteroanterior and L3 for lateral] and tibia pQCT scans were obtained in 65 CD subjects (ages 7-18 years) at diagnosis and 12 months later. BMD results were converted to sex, race, and age-specific Z-scores based on reference data in >650 children (ages 5-21 years). Multivariable linear regression models identified factors associated with BMD Z-scores. Results: At CD diagnosis, all BMD Z-scores were lower compared with the reference children (all p values <0.01). The pQCT vBMD Z-scores (-1.46∈±∈1.30) were lower compared with DXA PA-BMD (-0.75∈±∈0.98), PA-BMDHtZ (-0. 53∈±∈0.87), and WA-BMD (-0.61∈±∈1.10) among CD participants. Only PA-BMD Z-scores were correlated with height Z-scores at baseline (R∈=∈0.47, p∈<∈0.0001). pQCT and WA-BMD Z-scores increased significantly over 12 months to -1.04∈±∈1.26 and -0.20∈±∈1.14, respectively. Changes in all four BMD Z-scores were positively associated with changes in height Z-scores (p∈<∈0. 05). Glucocorticoid doses were inversely associated with changes in WA-BMD (p∈<∈0.01) only. Conclusions: Conventional and height Z-score-adjusted PA DXA methods did not demonstrate the significant increases in trabecular vBMD noted on pQCT and WA-BMD scans. WA-BMD captured glucocorticoid effects, potentially due to isolation of the vertebral body on the lateral projection. Future studies are needed to identify the BMD measure that provides greatest fracture discrimination in CD.

KW - Bone disease

KW - Crohn's disease

KW - DXA

KW - Glucocorticoids

KW - Growth

KW - Inflammation

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