Bone-muscle unit assessment with pQCT in children with inflammatory bowel disease following treatment with Infliximab

Mabrouka Altowati; S Malik; S Shepherd; McGrogan P; Russell RK; Ahmed SF; Wong SC

doi:10.1530/boneabs.4.P171

Objective: To evaluate bone and muscle mass in children with inflammatory bowel disease (IBD) following infliximab (IFX) therapy.

Methods: Prospective longitudinal study of 19 children (12 males), 17 crohn’s disease (CD), 1 ulcerative colitis (UC), 1 IBD unclassified (IBDU) of bone evaluation commencing treatment with IFX. Bone and muscle parameters were measured by pQCT at the non-dominant distal radius at 4 and 66% at baseline and 6 months. pQCT parameters for area were adjusted for height. Results reported as median (range).

Results: At baseline 7/19 (37%)had moderate/severe disease activity whereas at 6 months this was 1/19 (5%). At baseline median ESR (mm/h) was23 (3.0, 70) whereas at 6 months this was 13 (4.0, 56) P=0.09. At baseline, median albumin (mg/dl) was 33 (17, 42) whereas at 6 months this was 37 (20, 44) P=0.013. Nine children (47%) who were on oral Prednisolone at baseline discontinued at 6 months. Seven children (37%) were not on oral Prednisolone at baseline and 6 months. One child (5%) who was not on oral Prednisolone at baseline was on Prednisolone at 6 months whereas two children were on oral Prednisolone at baseline and 6 months.

Median volumetric BMD z-was −1.4 (−2.8, −0.4) at baseline and−1.4 (−2.8, −0.4) at 6 months (P=0.64). Median muscle area z-score were −1.8 (−4.3, −0.3) at baseline and −2.1 (−3.5, −0.5) and 6 months (P=0.93). Total alkaline phosphatase (UL) increased from 97 (37, 259) at baseline to 153 (29, 391) at 6 months (P<0.0001).In the seven children who were not on oral Prednisolone at baseline and 6 months, volumetric BMD z-score and muscle area z-score did not change. In the nine children who discontinued oral Prednisolone at 6 months, volumetric BMD z-score and muscle area z-score also did not change. In six children who did not progress in puberty, volumetric BMD z-score and muscle area z-score did not change. In the 12 children who showed progression in puberty, volumetric BMD z-and muscle area z-score also did not change.

Table 1
	Baseline	6 months	P value
Age (years)	14.8 (10.4,17.2)	15.3 (11.8,17.6)
Height SDS	−0.7 (−3.6,1.8)	−0.7 (−3.7,1.8)	0.75
Weight SDS	−0.4 (−3.7,3.1)	−0.2 (−2.7,2.8)	0.42
Prepubertal	2/19 (11%)	0/19 (0%)
Early/mid puberty	9/19 (47%)	7/19 (37%)
Late puberty	8/19 (42%)	12/19 (63%)
Paediatric Crohn’s Disease Activity Index	27.5 (0,57.5)	5.0 (0, 32.5)	< 0.0001
Oral Prednisolone	10/19 (52%)	3/19 (16%)	0.04

Conclusion: In this preliminary report, despite improvement in disease activity, reduction in oral steroid, progression in puberty and increase in plasma UL following therapy with IFX, muscle bone assessment using pQCT in children with IBD over the short period did not show improvement.

Disclosure: The authors declared no competing interests.

Bone Abstracts

P171