Tibia

Cohort

Surgery

Endocrinology

Bone mineral

Urology

Cortical bone

Biochemistry

Bone density

Bone resorption

Biomarker

Resorption

Internal medicine

Prospective cohort study

Medicine

Chemistry

Quantitative computed tomography

Osteoporosis

Pathology

The Journal of Clinical Endocrinology & Metabolism

Context: Pediatric Crohn's Disease (CD) is associated with deficits in trabecular bone mineral density (BMD) and cortical structure, potentially related to TNF-α effects to decrease bone formation and promote bone resorption. Objective: This study aimed to examine changes in bone density and structure in children and adolescents with CD following initiation of anti-TNF-α therapy. Design and Participants: Participants (n = 74; age 5–21 years) with CD completed a 12-month prospective cohort study. Main Outcome Measures: Tibia peripheral quantitative computed tomography scans were obtained at initiation of anti-TNF-α therapy and 12 months later. Musculoskeletal outcomes were expressed as sex-and race-specific z scores relative to age, based on &amp;gt;650 reference participants. Results: At baseline, CD participants had lower height, trabecular BMD, cortical area (due to smaller periosteal and larger endocortical circumferences), and muscle area z scores, compared with reference participants (all P &amp;lt; .01). Pediatric CD activity index decreased during the 10-week induction (P &amp;lt; .001), in association with subsequent gains in height, trabecular BMD, cortical area (due to recovery of endocortical bone), and muscle area z scores over 12 months (height P &amp;lt; .05; others P &amp;lt; .001). Bone-specific alkaline phosphatase levels, a biomarker of bone formation, increased a median of 75% (P &amp;lt; .001) during induction with associated 12-month improvements in trabecular BMD and cortical area z scores (both P &amp;lt; .001). Younger age was associated with greater increases in trabecular BMD z scores (P &amp;lt; .001) and greater linear growth with greater recovery of cortical area (P &amp;lt; .001). Conclusions: Anti-TNF-α therapy was associated with improvements in trabecular BMD and cortical structure. Improvements were greater in younger and growing participants, suggesting a window of opportunity for treatment of bone deficits.

Improvements in Bone Density and Structure during Anti-TNF-α Therapy in Pediatric Crohn's Disease