1 / 13

Skeletal Health in IBD: Screen, then treat (a.k.a. follow the guidelines)

Skeletal Health in IBD: Screen, then treat (a.k.a. follow the guidelines). Athos Bousvaros MD, MPH Boston Children’s Hospital. Disclosures. Consulting: Milennium , Dyax , Cubist, Nutricia Research support: Prometheus, Merck

luisa
Download Presentation

Skeletal Health in IBD: Screen, then treat (a.k.a. follow the guidelines)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Skeletal Health in IBD: Screen, then treat (a.k.a. follow the guidelines) Athos Bousvaros MD, MPH Boston Children’s Hospital

  2. Disclosures • Consulting: Milennium, Dyax, Cubist, Nutricia • Research support: Prometheus, Merck • With gratitude to Helen Pappa, Francisco Sylvester, and the NASPGHAN Skeletal Health working guideline. JPGN 2011

  3. Bone mass is acquired in childhood and adolescence

  4. Causes of low bone density in IBD patients Protein-calorie malnutrition Inflammation Delayed growth Delayed puberty Low muscle mass Hypovitaminosis D Glucocorticoids GENETICS

  5. How to approach the issue of low bone mineral density in pediatric IBD • Ignore it • Treat everybody • Screen and treat those who need to be treated

  6. Which recommendations to follow?THESE – Screen and treat Journal Pediatric GI and Nutrition 2011; 11-25

  7. Who to get DEXA on? • Growth failure • Height Z score <-2.0 SD • BMI <2.0 SD • Primary or secondary amenorrhea • Severe inflammatory disease, esp. hypoalbuminemia • > 6 months of steroid therapy • Clinically significant fractures

  8. What kind of DEXA to get • Children under 14 years • Total body and spine • Children 14 and over • Hip and spine • Cost under $150* *healthcarebluebook.com

  9. Who and when to get a 25 hydroxy vitamin D level on? • Everyone • African American children at higher risk* • Once a year, in the winter (cost-$30) • If low (<32 ng/ml), treat: • 50,000 units once a week for 10 weeks • Ensure adequate calcium intake during this period *Middleton, JPGN 2013; 57:587

  10. Why screen and treat? • Not everyone needs to be treated. • 60-70% of children with IBD will have a NORMAL BMD Z score • Low bone mineral density may change your therapeutic decisions • Additional data in patient decision making • Use steroid sparing agents (e.g. infliximab) • Implement nutritional therapy faster • More rigorous diet/exercise program • Referral to endocrinologist TREAT Don’t treat

  11. Why screen and treat? • Adherence, adherence, adherence!!!! • Approximately 70% of medication doses (ASA and thiopurine) are taken by children • Approximately 25% of adolescents take over 80% of their prescribed ASA doses • Approximately 15% of adolescents take their prescribed thiopurine doses. • Calcium and vitamin D = 2-3 extra tabs per day (cost $40/year) Leleiko IBD Journal 2013;19:832

  12. Summary: Screen and treat • Prevention of osteoporosis is important • Not everyone needs to be screened • Focus on the high risk groups • Not everyone needs to be treated • Treat those with BMD Z score <-1.0 • Treat suboptimal BMD like an extraintestinal manifestation of IBD • Control inflammation, optimize nutrition • Follow up, and monitor adherence

More Related