A recent retrospective study (N Ronel, et al. JPGN 2021; 72: 270-275. Clinical Criteria Can Identify Children With Osteopenia in Newly Diagnosed Crohn Disease) included 116 children (mean age 13 years)

Key finding:

• In total, 59% of children with BMI z-score <−0.5 had moderate-severe osteopenia and only 18% of those with higher z-scores. 
• Osteopenia was associated with lower BMI z-score (−0.8 ± 1.2 vs −1.8 ± 1.1, P < 0.001) and higher PCDAI  (33.7 ± 15.2 vs 25.7 ± 16.5; P = 0.009)
• None of the higher risk patients were receiving long-term corticosteroids 
• Limitations: retrospective study with relatively small sample size, pubertal stage not recorded, variability in DXA studies, and lack of followup information

My take: The authors have NOT shown that identification of osteopenia at the time of diagnosis improves outcome of Crohn’s disease or bone disease. This is why I disagree with their recommendation to routinely screen children with BMI z-score <−0.5. In those in which finding osteopenia may influence treatment, then a DXA study would be worthwhile.

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