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Risk of diagnosed fractures in children with inflammatory bowel diseases

Kappelman, Michael D. MD, MPH1,*; Galanko, Joseph A. PhD1; Porter, Carol Q. BS1; Sandler, Robert S. MD, MPH1

doi: 10.1002/ibd.21472
Original Clinical Articles

Background:: Decreased bone mass is common in children with inflammatory bowel disease (IBD); however, fracture risk is unknown. We sought to evaluate fracture risk in children with IBD as compared to unaffected controls and determine whether this risk is affected by geographical region (a proxy for sun/vitamin D exposure) and oral steroid use.

Methods:: We identified cases of Crohn's disease (CD) and ulcerative colitis (UC), less than 20 years of age, using administrative data from 87 health plans. Each case was matched to three controls on the basis of age, gender, and geographical region. We identified fractures in cases and controls using ICD‐9 diagnosis codes and measured oral steroid exposure using NDC codes.

Results:: The study included 733 children with CD, 488 with UC, and 3287 controls (mean age 15 years). IBD was not associated with a higher risk of fracture at any site (CD odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6‐1.1; UC OR 1.4, 95% CI 1.0‐2.1) or at multiple sites (CD OR 0.8, 95% CI 0.4‐1.7; UC OR 0.4, 95% CI 0.1‐1.4). Among IBD patients we did not identify any significant differences in the fracture rate between those residing in the Northeast/Midwest versus the South (OR 1.3, 95% CI 0.8‐2.2). Steroid exposure was not associated with the occurrence of fractures (P = 0.6).

Conclusions:: Children with IBD are no more likely to have experienced a diagnosed fracture than age‐, sex‐, and gender‐matched controls. (Inflamm Bowel Dis 2010)

1 University of North Carolina Chapel Hill, Chapel Hill, North Carolina

*Reprints: University of North Carolina Chapel Hill, Department of Pediatrics, Division of Pediatric Gastroenterology, 130 Mason Farm Road, campus box 7229, Chapel Hill, NC 27599

Email: michael_kappelman@med.unc.edu

Received 29 July 2010; Accepted 30 July 2010

Published online 24 September 2010 in Wiley Online Library (wileyonlinelibrary.com).

Grant sponsor: National Center for Research Resources (NCRR) Grant; Grant Number: KL2 RR025746 (MDK); Grant sponsor: National Institute for Diabetes and Digestive and Kidney Diseases Grant; Grant Number: P30 DK034987.

© Crohn's & Colitis Foundation of America, Inc.
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