Risk factors for osteopenia and osteoporosis:
(1) long-term or high dose corticosteroid therapy
(2) active disease with high levels of inflammatory cytokines
(3) poor dietary intake or malabsorption of calcium and/or vitamin D
(4) low body mass index (BMI)
(5) inactive lifestyle
(6) postmenopausal state in females
Osteopenia and osteoporosis can be a significant problem for children with IBD. A child with IBD is at increased risk for fracture, which can result in a false diagnosis of child abuse.
Any patient with IBD should be screened for osteopenia. Imaging studies that compare bone density to age-based reference levels need to take into account any accompanying growth retardation (which is associated with a decrease in bone area). Failure to interpret bone density studies in light of growth retardation can result in overdiagnosis of osteopenia.
Management of osteopenia or osteopenia may include:
(1) weight-bearing exercise
(2) minimize use of corticosteroids
(3) optimize intake of calcium, vitamin D and other nutrients
(4) medications to control disease activity
(5) therapy with bisphosphonates
