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Open Access Research article

Fibroblast growth factor 23 contributes to diminished bone mineral density in childhood inflammatory bowel disease

Mostafa Abdel-Aziz El-Hodhod1*, Ahmad Mohamed Hamdy1, Amal Ahmed Abbas2, Sherine George Moftah3 and Alhag Ahmed Mohamed Ramadan4

Author Affiliations

1 Department Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt

2 Department Clinical & Chemical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

3 Department Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt

4 Pediatrician, Ministry of Health, Cairo, Egypt

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BMC Gastroenterology 2012, 12:44  doi:10.1186/1471-230X-12-44

Published: 2 May 2012

Abstract

Background

Diminished bone mineral density (BMD) is of significant concern in pediatric inflammatory bowel disease (IBD). Exact etiology is debatable. The recognition of fibroblast growth factor 23 (FGF23), a phosphaturic hormone related to tumor necrosis factor alpha (TNF-α) makes it plausible to hypothesize its possible relation to this pathology.

Methods

In this follow up case control study, BMD as well as serum levels of FGF23, calcium, phosphorus, alkaline phosphatase, creatinine, parathyroid hormone, 25 hydroxy vitamin D3 and 1, 25 dihydroxy vitamin D3 were measured in 47 children with IBD during flare and reassessed in the next remission.

Results

Low BMD was frequent during IBD flare (87.2%) with significant improvement after remission (44.7%). During disease flare, only 21.3% of patients had vitamin D deficiency, which was severe in 12.8%. During remission, all patients had normal vitamin D except for two patients with Crohn’s disease (CD) who remained vitamin D deficient. Mean value of serum FGF23 was significantly higher among patients with IBD during flare compared to controls. It showed significant improvement during remission but not to the control values. 1, 25 dihydroxy vitamin D3, FGF23, serum calcium and urinary phosphorus were significant determinants of BMD in IBD patients.

Conclusions

We can conclude that diminished BMD in childhood IBD is a common multifactorial problem. Elevated FGF23 would be a novel addition to the list of factors affecting bone mineral density in this context. Further molecular studies are warranted to display the exact interplay of these factors.

Keywords:
IBD; Children; FGF23; Bone mineral density