Improvements in Bone Density and Structure during Anti-TNF-alpha Therapy in Pediatric Crohn’s Disease, Griffin L, et al. J Clin Endocrinol Metab. 2015;doi:10.1210/jc.2014-4152.
Patients with inflammatory bowel disease (IBD) have a higher chance of developing osteoporosis (thinning of the bones). A number of research studies have documented reduced bone mass and increased fracture rates in children and adults with Crohn’s disease (CD). Tumour necrosis factor alpha (TNFα) is a molecule that plays a role in inflammation and affects bone health. Infliximab is an anti-TNFα treatment used in CD.
This study examined the effect of infliximab treatment on bone health in children and young adults with CD. The researchers studied 74 children and young adults, aged between 5 and 21 years, who were starting infliximab for CD at Children’s Hospital of Philadelphia. Various tests to measure bone density and structure including CT scans of the shinbone to measure the thickness of the bone were done at the start and 12 months after treatment began. More than 650 healthy children participating in a larger study of bone health served as a control group.
The results showed that at the start of treatment, CD patients were shorter and had thinner bones compared with the healthy group. During the course of treatment with infliximab, there was not just an improvement in their CD but also a rapid improvement in the height and thickness of their bones. The researchers also reported this change was more striking in the younger aged patients who demonstrated a greater capacity for recovery of bone mass. The authors suggest that the effect of infliximab on bone health is related to its anti-TNFα action.
There are some limitations to this study. It is not clear how much of the beneficial effect is due to infliximab and how much is due to the fact that children grow better and eat better when their CD is better. The study period was only over 12 months and a longer follow up study is needed to determine whether these patients have reduced rates of fractures and overall improved height. However, this is the first study of its kind to describe the potential of bone recovery with the use of infliximab therapy in CD. It reinforces an important issue of maintaining good bone health in patients with IBD and will hopefully be the first of many such studies to come.