Koštani status u djece oboljele od kronične upalne bolesti crijeva [Bone status in children with inflammatory bowel disease]

Senečić-Čala, Irena (2010) Koštani status u djece oboljele od kronične upalne bolesti crijeva [Bone status in children with inflammatory bowel disease]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

In children with inflammatory bowel disease impairment of bone metabolism may occur with increased risk of osteoporosis in adulthood. The incidence and causes of bone disorder are not well evaluated. The aim of this study was to evaluate bone metabolism and its impairment by determining the incidence of bone mineralization disorder and to indentify the influence of different clinical factors on bone status. Therefore, bone metabolism was assessed by DXA, calcaneal ultrasound and biochemical parameters of bone turnover in 58 children with inflammatory bowel disease. Three times measurements during one year were performed. Decreased bone mineral density was found in 10% od patients at the begining , and in 8,7% of patients at the end of the study. There were no difference in groups according to diagnosis and gender. The positive influence of nutritional status and growth on bone mineral density was significant. The negative influence of vitamin D deficiency was not confirmed, but the majority of patients received vitamin D and calcium supplements. There was no correlation between pubertal development and bone mineral density obtained by DXA. The positive effect of enteral nutrition on bone mineralization was not confirmed. The duration of disease and steroid treatment were not identified as risk factors for bone mineral disorder in this study. However, significant negative correlation of disease activity with biochemical and ultrasound parameters was found. This study also showed that during one year of follow up, with better control of the disease, growth and pubertal development were maintained and nutritional status improved in our patients. Accordingly, the dynamics od bone metabolism changed towards bone modeling, growth and increased bone mineralization.

Abstract in Croatian

U djece s kroničnom upalnom bolešću crijeva može se javiti poremećaj koštanog metabolizma koji se očituje smanjenom mineralnom gustoćom kosti i povećanim rizikom nastanka osteoporoze u odrasloj dobi. Uzroci nastanka koštanog poremećaja kao niti njegova učestalost nisu u cijelosti ispitani. Primarni cilj ovog rada bio je ispitivanje koštanog metabolizma i njegovog poremećaja na način da se utvrdi učestalost poremećaja mineralizacije kosti i ispita utjecaj različitih čimbenika na koštani status. Stoga smo pratili koštani metabolizam pomoću DXA, ultrazvuka petne kosti i biokemijskih parametara koštanog preoblikovanja u 58 djece s kroničnom upalnom bolešću crijeva, u tri mjerenja tijekom perioda od godinu dana. Rezultati istraživanja su pokazali da je u naših ispitanika smanjena koštana masa prisutna u 10% na početku, i u 8,7% ispitanika na kraju studije. Nije bilo razlika između skupina djece prema dijagnozi i prema spolu. Utjecaj stanja uhranjenosti i rasta na mineralnu gustoću kosti pokazao se pozitivan i značajan. Nepovoljan utjecaj hipovitaminoze D na mineralizaciju kosti nije dokazan uz napomenu da je većina ispitanika bila na supstituciji kalcija i vitamina D. Nije nađena povezanost mineralne gustoće kosti pomoću DXA i stupnja spolnog razvoja. Nije dokazan pozitivan učinak enteralne prehrane na mineralnu gustoću kosti. Dulje trajanje bolesti kao niti liječenje steroidima nisu u ovom ispitivanju bili značajni čimbenici za nastanak poremećaja mineralizacije kosti. Međutim, jasna je negativna povezanost aktivnosti bolesti s biokemijskim i ultrazvučnim denzitometrijskim parametrima. Ovo istraživanje je također pokazalo, da se u djece s kroničnom upalnom bolešću crijeva tijekom praćenja, s boljom kontrolom osnovne bolesti, poboljšao nutritivni status bolesnika i održao primjeren rast i spolni razvoj. Sukladno tomu, dinamika se koštanog metabolizma mijenjala prema izgradnji, rastu i poboljšanoj mineralizaciji kosti.

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