Current evidence points to suboptimal bone health in children and adolescents with inflammatory bowel disease (IBD) when compared with their healthy peers. This compromise is evident from diagnosis. The clinical consequences and long-term outcome of this finding are still unknown. The mechanism of suboptimal bone health in children and adolescents with IBD lays mainly in reduced bone formation, but also reduced bone resorption, processes necessary for bone growth. Factors contributing to this derangement are inflammation, delayed growth and puberty, lean mass deficits, and use of glucocorticoids. We recognize that evidence is sparse on the topic of bone health in children and adolescents with IBD. In this clinical guideline, based on current evidence, we provide recommendations on screening and monitoring bone health in children and adolescents with IBD, including modalities to achieve this and their limitations; monitoring of parameters of growth, pubertal development, and reasons for concern; evaluation of vitamin D status and vitamin D and calcium intake; exercise; and nutritional support. We also report on the current evidence of the effect of biologics on bone health in children and adolescents with IBD, as well as the role of bone active medications such as bisphosphonates. Finally, we summarize the existing numerous gaps in knowledge and potential subjects for future research endeavors.
*Division of Gastroenterology and Nutrition, Children's Hospital Boston, USA
†Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, USA
‡Division of Digestive Diseases, Hepatology and Nutrition, Connecticut Children's Medical Center, USA
§Division of Nephrology, Center for Clinical Epidemiology and Biostatistics, The Children's Hospital of Philadelphia, USA
||Divisions of Endocrinology and Adolescent Medicine, Bone Health Center, Children's Hospital Boston, USA.
Received 9 February, 2011
Accepted 18 February, 2011
Address correspondence and reprint requests to Helen Pappa, MD, MPH, Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA 02115 (e-mail: firstname.lastname@example.org).
Dr Gordon is the co-director, Clinical Investigation Training Program (Harvard/MIT with Pfizer/Merck). The other authors report no conflicts of interest.