Bone mineralization disorder in children with inflammatory bowel disease

master's thesis

• Title (croatian): Poremećaj mineralizacije kostiju u djece s kroničnom upalnom bolešću crijeva
• Author: Lea Helena Bach-Bachich
• Mentor: Irena Senečić-Čala (mentor)
• Committee member: Duška Tješić-Drinković (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Irena Senečić-Čala (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Chronic inflammatory disorders such as Inflammatory Bowel Disease have a considerable effect on the metabolism of bone and are generally associated with Bone Mineral Disease (BMD). In children and adolescents, it is of particular importance because not only does it increase the risk of fracture but it has a deleterious effect on overall bone growth, development and peak bone mass. The mechanisms contributing to bone abnormalities are multifactorial, however the most important is inflammatory cytokines found in high amounts in inflammatory diseases, the use of corticosteroids for treatment of IBD, lack of proper nutritional status and a delay in puberty in active disease. All mechanisms are correlated with one another, so there is difficulty in pinpointing what the real culprit behind the skeletal abnormalities is. Current diagnostic methods consist of several radiating and non-radiating and laboratory techniques, the most widely used and available of which is the DXA scan. Measurements from DXA scan are correlated to Z-scores that are standardized based on age and gender. With proper z-score measurment we can attempt to properly treat children and adolescents with pediatric-onset IBD before they reach their peak bone mass. Nutritional interventions such as dietary Vitamin D and Calcium supplementation, even though are widely used, are not shown yet of substantial efficacy in patients with IBD. With understanding the mechanisms of BMD in Ulcerative Colitis and Crohn's Disease, it is crucial to focus on the development of targeted therapies that work to maximize growth yet limit disease activity in children with IBD.

Abstract (croatian)

Kronični upalni poremećaji, kao što je upalna bolest crijeva, znatno utječu na metabolizam kostiju i općenito su povezani s poremećajem mineralizacije kostiju. U djece i adolescenata to je od osobite važnosti jer ne samo da je povećan rizik od prijeloma kostiju, nego je dokazan negativan učinak na ukupni rast kosti, razvoj i vršnu koštanu masu. Mehanizmi koji pridonose abnormalnom razvoju kostiju su multifaktorni, međutim najvažniju ulogu imaju upalni citokini koji se nalaze u velikim količinama kod upalnih bolesti, zatim primjena kortikosteroida u liječenju, nedostatak odgovarajućih nutrijenata, i kašnjenje puberteta u aktivnoj bolesti. Navedeni mehanizmi su međusobno povezani jedni s drugima, stoga je teško odrediti koji je pravi uzrok za abnormalnosti u razvoju kostiju. Trenutne dijagnostičke metode uključuju nekoliko radijacijskih i ne-radijacijskih te laboratorijskih tehnika, od kojih je najčešće korištena i dostupna DXA denzitometrija. Mjerenja iz DXA skeniranja koreliraju se s Z-vrijednostima koje su standardizirane na temelju dobi i spola. S tim spoznajama možemo pokušati pravilno liječiti djecu i adolescente s ranim nastupom upalne bolesti crijeva, prije nego što dosegnu svoju vršnu masu kostiju. Dodatak vitamina D i kalcija u prehrani, iako se primjenjuje, nije za sada pokazao značajni učinak u bolesnika s upalnim bolestima crijeva. Uz razumijevanje mehanizma mineralne bolesti kostiju kod ulceroznog kolitisa i Crohnove bolesti, ključno je usredotočiti se na razvoj ciljanih terapija koje potiču rast, ali istovremeno ograničavaju aktivnost bolesti kod djece s upalnim bolestima crijeva.

• Keywords: BMD; IBD; Crohns; Ulcerative Colitis; DXA; Vitamin D; Calcium; Z-score; peak bone mass
• Keywords (croatian): poremećaj mineralizacije kostiju; upalna bolest crijeva; ulcerozni kolitis; Crohnova bolest; DXA denzitometrija; vitamin D; kalcij; Z-vrijednost; vršna masa kostiju
• Language: english
• URN:NBN: urn:nbn:hr:105:320226
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-04-26 11:41:00