By Will Boggs, MD

NEW YORK (Reuters Health) - Children with Crohn's disease have deficits in the muscle and bone that are unrelated to steroid treatment, which can also adversely effect the bones, and these problems do not completely resolve with treatment, according to a report in the journal Gastroenterology.

Many physicians attribute the bone damage that occurs in patients with inflammatory bowel disease to steroid therapy, Dr. Mary B. Leonard, from Children's Hospital of Philadelphia, told Reuters Health. "However, these kids had bad bone disease prior to any glucocorticoid therapy, and glucocorticoids were not associated with progression of bone disease."

Leonard and colleagues used a specialized CT imaging device (peripheral quantitative CT) to measure bone and muscle parameters in children with Crohn's disease before and after glucocorticoid therapy.

Bone mineral density and bone loss were observed in children with Crohn's disease before treatment, compared with a cross-sectional sample of healthy control children, the authors report.

Crohn's disease patients also had lower body mass index and lower muscle cross-sectional area than did controls.

Data were available for 67 children after 1 year of treatment with glucocorticoids. Treatment produced significant improvements in Crohn's disease activity scores, the researchers note, and these improvements were accompanied by recovery of body mass index, muscle and fat parameters.

Despite treatment and symptom improvement though, the children continued to have significantly lower bone mineral density and muscle scores than controls.

The persistence of deficits was surprising. "We thought that the bone would improve more rapidly as the underlying inflammatory bowel disease was treated and children received nutritional support," Leonard said.

"Children with chronic inflammatory conditions, especially Crohn's disease, are at risk for significantly impaired bone accretion," she added. "Physicians should review calcium and vitamin D intake and should monitor bone health."

The muscle and bone structural findings before treatment "emphasize the need to test nutritional interventions in these patients, as well as the effect of 'anabolic' agents, therapies that may both significantly impact lean muscle mass and enhance bone strength," writes Dr. Catherine M. Gordon from Children's Hospital Boston in a related editorial.

Leonard also mentioned a new strategy that her group is testing. "Based on the findings in these children, the National Institutes of Health awarded us $3 million to conduct a study of whole body vibration as a therapy to improve bone health in children with Crohn's disease," she explained.

"The study ('Healthy Vibrations') is underway. We have enrolled 81 children to date and have installed vibrating platforms in the homes where the children and adolescents will do daily 10-minute treatments for 12 months. We hope to enroll an additional 79 children over the coming year."

SOURCE: Gastroenterology, January 2009.

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