Journal of Bone Metabolism · 6 authors, 5 centres
This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.
This cross-sectional study of 48 pediatric IBD patients in Bahrain found that 27.1% had osteoporosis and 33.3% had osteopenia on total body DXA scans. Low BMI, ileocolonic disease location, low calcium, low hemoglobin, and infliximab use were significant predictors of low bone mineral density. These findings highlight the need for early BMD screening in children with IBD.
**Background:** Inflammatory bowel disease (IBD) is a chronic immune-mediated condition affecting the gastrointestinal tract that can impair bone growth and bone mineral density (BMD) in children. This study aimed to measure the prevalence and identify predictors of low BMD in pediatric IBD patients in the Kingdom of Bahrain, where no prior pediatric data existed.
**Methods:** This retrospective cross-sectional analytical study included pediatric patients (≤18 years) with IBD who underwent BMD evaluation via dual energy X-ray absorptiometry (DXA) of the total body and lumbar spine at Salmaniya Medical Complex between April 2013 and September 2022. Osteoporosis was defined as BMD Z-score ≤−2, osteopenia as −2 to −1, and normal as >−1. Clinical characteristics, laboratory findings, and medication use were compared between osteoporotic and non-osteoporotic patients using univariate analysis. Disease location was classified per the Paris classification.
**Key Results:** Of 152 registered pediatric IBD patients, 48 (31.6%) who underwent DXA were included. The cohort was 62.5% male (30/48), 72.9% had Crohn's disease (35/48), and 27.1% had ulcerative colitis (13/48). Mean age at diagnosis was 9.9±2.8 years; median age at BMD scan was 11.9 years (IQR 9.9–14.3). Total body BMD scans identified osteoporosis in 13/48 (27.1%) and osteopenia in 16/48 (33.3%). Spinal BMD scans revealed osteoporosis in 17/43 (39.5%) and osteopenia in 14/43 (32.6%). Significant predictors of osteoporosis on total body BMD included low BMI Z-score (P=0.038), ileocolonic disease location (P=0.008), and low calcium level (P=0.008). On spinal BMD, significant predictors were low BMI Z-score (P=0.039), decreased hemoglobin (P=0.018), low calcium (P=0.033), and infliximab use (P=0.019). A one-way ANOVA showed significant differences in mean total body BMD Z-scores across disease locations (F(2,34)=4.326, P=0.021), with small bowel involvement (−3.2±1.1) significantly lower than colonic disease (−0.9±1.1) by LSD post-hoc test (P=0.017), though not significant by Bonferroni correction (P=0.050). Laboratory abnormalities included anemia (69.5%), low 25(OH) vitamin D (72.5%), high CRP (68.9%), and high ESR (60.9%).
**Clinical Implications:** This first pediatric BMD study in Bahrain demonstrates a high prevalence of low BMD among children with IBD, with rates comparable to regional studies (e.g., 39% osteoporosis in Saudi Arabia) but higher than some Western reports. Identified modifiable risk factors—low BMI, low calcium, low hemoglobin, and severe disease requiring infliximab—provide targets for early intervention. The findings support routine BMD screening in pediatric IBD patients, particularly those with ileocolonic disease, low BMI, or biochemical abnormalities. Limitations include small sample size (n=48), single-center design, and lack of a healthy control group. Further research is needed on mechanisms and treatment responses.