Vitamin D Deficiency And Abnormal Bone Density In Pediatric Patients With Inflammatory Bowel Disease

Previous studies have identified a relationship between vitamin D deficiency and inflammatory bowel disease. We proposed to identify the number of patients with IBD seen in our practice who had vitamin D deficiency. We also correlated the vitamin D levels with the findings on DEXA scan in these patients. We further assessed the clinical status of these patients with use of PCDAI for Crohns and PUCAI in ulcerative colitis. This was a retrospective chart review of 120 patients seen in our outpatient practice with a diagnosis of Inflammatory Bowel Disease (Crohn's, Ulcerative Colitis, or Indeterminate Colitis). Demographic data was gathered including patient's age at time of diagnosis, age at measurement of vitamin D level, diagnosis, extent of disease, medications used, and DEXA scan Z-score of Lumbar spine if results were available. Of the 110 patients studied 63.6% were found to be Vitamin D deficient. 64% of the Vitamin D deficient patients were prescribed Vitamin D supplementation. Of the Vitamin D deficient patients 87% got DEXA scans. Of the patients who were Vitamin D deficient who got DEXA scans 42.6% were abnormal. Of the patients with evidence of osteopenia on DEXA scan, a repeat DEXA scan was obtained which showed improvement after being started on vitamin D supplementation with normalization of vitamin D levels. Serum vitamin D concentration was positively correlated with disease activity based on PCADI and PUCAI. There was also a correlation between use of corticosteroids and vitamin D deficiency. Identifying and treating vitamin D deficiency in pediatric patients with IBD is critical to their bone health. Vitamin D status needs to be assessed more closely in patients who have more aggressive disease.