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Inflammatory Bowel Diseases and Skeletal Health

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Pediatric Inflammatory Bowel Disease

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Abstract

Bone and muscle constitute a functional unit, which is essential for locomotion. The muscle-bone unit is frequently affected by inflammatory bowel disease (IBD) and in children especially by Crohn disease. Muscle mass is significantly reduced (cachexia) at diagnosis in children with Crohn disease. These deficits persist despite adequate clinical response to anti-inflammatory therapy and catch-up weight gain. Bone mass and bone architecture are both compromised in pediatric Crohn disease. Linear growth and bone modeling and remodeling are all affected. As a result, bones are shorter. Osteoclasts expand the bone marrow cavity of long bones, while osteoblasts do not expand the periosteal envelope at the same rate, producing a thinner cortex. The cortical bone density is however augmented, probably due to inhibited bone remodeling. Trabecular bone mass may be reduced secondary to decreased bone formation. These changes in IBD can affect bone and muscle by multiple mechanisms including malnutrition (resulting in deficits of macro- and micronutrients), inflammatory cytokines and activated T cells, inhibition of sex steroids and insulin-like growth factor 1, and inactivity. In addition, corticosteroids can directly cause muscle loss, inhibit bone formation, and indirectly increase bone resorption. Antitumor necrosis factor-α and exclusive enteral nutrition on the other hand can reconstitute linear growth and bone modeling and remodeling. In this chapter, we discussed in detail the muscle-bone phenotype in human IBD and animal models of IBD. We also present possible mechanisms by which IBD affects the muscle-bone unit and some options to ensure the achievement of peak bone mass in children with IBD.

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  1. The University of North Carolina at Chapel Hill, 333 South Columbia Street 247 MacNider Hall, Chapel Hill, NC, USA

    Francisco Sylvester MD

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Editors and Affiliations

  1. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Petar Mamula

  2. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Andrew B. Grossman

  3. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Robert N. Baldassano

  4. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Judith R. Kelsen

  5. Division of Pediatric Gastroenterology & Nutrition, University of South Carolina School of Medicine - Greenville, Greenville, South Carolina, USA

    Jonathan E. Markowitz

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Sylvester, F. (2017). Inflammatory Bowel Diseases and Skeletal Health. In: Mamula, P., Grossman, A., Baldassano, R., Kelsen, J., Markowitz, J. (eds) Pediatric Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-49215-5_13

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