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J Pediatr Gastroenterol Nutr, 2018; 67(6): 738-744, PMID: 30052566

Persistence of muscle-bone deficits following anti-tumor necrosis factor therapy in adolescents with crohn"s disease.

Year: 2018

Altowati MMA, Shepherd S, McMillan M, McGrogan P, Russell R, Ahmed SF, Wong SC
Developmental Endocrinology Research Group, Royal Hospital for Children, Glasgow, United Kingdom.


OBJECTIVES: To assess change in the muscle-bone unit in adolescents with Crohn"s disease (CD) on anti-tumor necrosis factor (anti-TNFalpha). METHODS: Prospective study following anti-TNFalpha 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 (IGF) 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 SDS increased from -1.7 (-3.6, -1.0) to -1.2 (-3.6, -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, 0.5) and -1.1 (-2.9, 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, 1.1) and -2.4 (-4.3, -0.3), respectively. At baseline, maximal isometric grip force (MIGF) of the non-dominant hand adjusted for height was -1.5 (-4.5, 0.49). All these deficits in muscle-bone persisted at 6 and 12 months. CONCLUSION: 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-TNFalpha.

GID: 4747; Last update: 29.08.2018