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Persistence of Muscle-bone Deficits Following Anti-tumour Necrosis Factor Therapy in Adolescents With Crohn Disease

Altowati, Mabrouka M.A.*; Shepherd, Sheila*; McMillan, Martin*; McGrogan, Paraic; Russell, Richard; Ahmed, S. Faisal*; Wong, Sze Choong*

Journal of Pediatric Gastroenterology and Nutrition: December 2018 - Volume 67 - Issue 6 - p 738–744
doi: 10.1097/MPG.0000000000002099
Original Article: Gastroenterology: Inflammatory Bowel Disease

Objectives: The aim of the study is to assess change in the muscle-bone unit in adolescents with Crohn disease (CD) on anti-tumour necrosis factor (anti-TNFα).

Methods: Prospective study following anti-TNFα in 19 adolescents with CD with a median age (range) of 15.1 years (11.2, 17.2). At baseline, 6 and 12 months, subjects had a biochemical assessment of insulin growth factor axis, bone turnover and muscle-bone health by dual energy absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), and dynamic isometry.

Results: Significant clinical improvement in disease activity was observed by 2 weeks (P = 0.004 vs baseline) and maintained at 12 months (P = 0.038 vs baseline). Median bone specific alkaline phosphatase standard deviation score (SDS) increased from −1.7 (−3.6 to −1.0) to −1.2 (−3.6 to −0.5) by 6 weeks (P = 0.01). At baseline, DXA total body and lumbar spine bone mineral density (BMD) SDS was −0.9 (−2.3 to 0.5) and −1.1 (−2.9 to 0.4), respectively. At baseline, pQCT trabecular BMD SDS at 4% tibia and muscle cross-sectional area SDS at 66% radius was −1.6 (−3.2 to 1.1) and −2.4 (−4.3 to −0.3), respectively. At baseline, maximal isometric grip force (MIGF) of the non-dominant hand adjusted for height was −1.5 (−4.5 to 0.49). All these deficits in muscle-bone persisted at 6 and 12 months.

Conclusions: Despite improvement in disease and osteoblast activity, bone and muscle deficits, as assessed by DXA, pQCT, and grip strength in adolescents with CD did not improve following twelve months of anti-TNFα.

*Developmental Endocrinology Research Group

Department of Pediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK.

Address correspondence and reprint requests to Sze Choong Wong, DMedSci, Developmental Endocrinology Research Group, Royal Hospital for Children, Office Block, Ground Floor, Zone 1, RHC & QEUH Campus, 1345 Govan Road, Glasgow G51 4TF, UK (e-mail:

Received 12 May, 2018

Accepted 5 July, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

R.K.R. has received speaker's fees, travel support, and participated in medical board meetings with Abbvie, Napp, Nestlé Health Science, Celltrion, Shire and Janssen. The other authors have nothing to disclose in relation to this current submission.

© 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,