Keuning, M.C. (Martje Christine) (2013) ‘Factors influencing bone mineral density and strength changes in pediatric patients with inflammatory bowel disease: a prospective study’. thesis, Medicine.
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Abstract
Background: The prevalence of low bone mineral density (BMD) is high among pediatric patients with inflammatory bowel disease (IBD), during a period in their lives when they should experience the most rapid acquisition of bone mass. Guidelines for the treatment or prevention of this condition in children and adolescents with IBD are lacking. Vitamin D is essential for bone mineralization and remodeling and it may play an important role in bone health in states of inflammation as well. As the potential protective effect of optimizing the vitamin D status on bone health in these patients has not yet been studied, we plan to examine the effect of vitamin D in promoting bone health. Furthermore, this study will investigate other factors affecting bone mineral density and strength changes. The primary hypothesis is that higher and seasonal adjusted daily doses of vitamin D2 will more efficacious in achieving greater bone mineral accrual scores, than a conventional daily dose of oral vitamin D2. The secondary hypothesis is that other factors affecting bone health can be identified. Methods: prospective study In a randomized controlled trial design, 63 participants were recruited from Children’s Hospital Boston. Subjects were randomized in two arms to compare two regimens of vitamin D2 supplementation, 400 IU daily (arm A) or 2,000 IU/1000 IU daily (arm B) depending on the season, and their effect on bone health. Patient characteristics, dual energy X-ray absorptiometry (DXA) scans, peripheral quantitative computed tomography (pQCT), anthropometry, disease related variables, laboratory analysis and compliance were obtained from the study subjects, at multiple visits. Follow-up visits occurred at 3-month intervals until the study (12 months in total) was completed. Multivariate analysis was used to establish differences between the treatment arms and change in BMD Z-scores, change in bone parameters and pQCT measurements. Regression analysis was used to determine other factors influencing the change in bone health outcomes. Results: Change in DXA and pQCT measurements showed no significant differences between arm A (n=32) and arm B (n=31). The whole-group analysis presented an increase BMD over the 12-month study period. Total body BMD Z-scores were negatively influenced by more severe disease activity and fat mass. Spine BMD Z-scores appeared to be positively influenced by lean mass and negatively affected by the use of glucocorticoids. Conclusions: In children with IBD, we found that higher daily oral doses of vitamin D supplementation (up to 2,000 IU) were not more beneficial than the conventional doses in promoting bone health. Other factors that were found to affect bone mass accrual were disease activity, lean and fat mass, upper gastro-intestinal involvement and use of glucocorticoids.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Rings, Prof. Dr. E.H.H.M. |
| Supervisor name: | Pappa, Helen M. MD and GI/ Nutrition and Children’s Hospital Boston |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:47 |
| Last Modified: | 25 Jun 2020 10:47 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/879 |
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