ESPE Abstracts (2019) 92 LB-25

Low Trabecular Bone Score in Children with Inflammatory Bowel Diseases

Yael Levy Shraga1,2, Ophir Megnazi2, Dalit Modan-Moses1,2, Liana Tripto-Shkolnik3,2, Noah Gruber 1,2, Yael Haberman4,2, Dror Shouval4,2, Batia Weiss4,2


1Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel. 2The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. 3Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel. 4Division of Pediatric Gastroenterology and Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel


Background: Trabecular bone score (TBS) is an emerging technology to assess bone microarchitecture of the lumbar spine. In adults, this score has been shown to be a significant predictor for osteoporotic fractures, independently of major clinical risk factors and bone mineral density (BMD), and is a recommended tool in the evaluation and management of osteoporosis, especially secondary osteoporosis. To date, only few studies evaluated TBS in the pediatric population. To the best of our knowledge, no previous study investigated TBS in pediatric inflammatory bowel diseases (IBD) patients.

We aimed to assess TBS in children with IBD and to evaluate correlations with clinical, laboratory and densitometric variables.

Methods: A retrospective study of TBS and BMD measurements by dual-energy X-ray absorptiometry (DXA) of children with IBD. Clinical, anthropometric and laboratory data were retrieved from the medical charts. Bone mineral apparent density (BMAD) was calculated for each participant.

Results: Thirty-five patients (age at diagnosis 12.6±3.4 years, 22 males) were included. Mean BMD L1-4 z-score of the cohort was -1.160±0.965, mean BMD TBLH z-score was -0.486±1.033, and mean BMAD z-score was -1.17±1.15.

Mean TBS was 1.359±0.090, lower than expected in healthy children in the same age and gender (TBS SD=-0.378, P=0.016). TBS was significantly correlated with weight-SDS (r=0.635, P<0.001), body mass index (BMI)-SDS (r=0.491, P=0.003), and DXA measurements: lumbar spine bone mineral content (BMC) (r=0.434, P=0.009) and total body less head (TBLH) BMD Z-score (r=0.434, P=0.009). In a subgroup of patients (n=13) who performed the DXA scan close to the diagnosis of IBD, a negative correlation was found between TBS and fecal calprotectin at diagnosis (r=-0.674, P=0.016). A stepwise linear regression analysis identified BMI z-score as an independent predictor of TBS (r²=0.469, P<0.001).

Conclusions: TBS of children and adolescents with IBD is lower than TBS of healthy children and correlates with BMI, BMC and BMD. This finding may likely reflect the deteriorative effect of IBD on bone microarchitecture.

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