Nasal Calcitonin Spray Doesn't Help Bone Health in Kids With IBD

Megan Brooks

May 13, 2011

NEW YORK (Reuters Health) May 13, 2011 — A randomized trial of intranasal calcitonin did not improve bone mineral density (BMD) in young people with inflammatory bowel disease (IBD).

The study did show that improved nutritional status, catch-up linear growth, reduced inflammation, increase in weight-bearing activity and cutting out caffeine "may be helpful" in restoring bone density in children with IBD, the researchers say.

"We were pleased to find that nutrition, exercise, and control of inflammation were beneficial in this population," Dr. Helen M. Pappa, of the IBD Center at Children's Hospital Boston in Massachusetts, told Reuters Health in an email. The study was published online April 26th in the American Journal of Gastroenterology.

Several studies have shown compromised bone mineralization in pediatric IBD. In a recent interventional study, vitamin D in daily doses equivalent to 1,700 IU with calcium supplementation did not have a significant impact on bone health in children with IBD.

There is some evidence that calcitonin may improve bone health in children. It's been shown to increase BMD in children after renal transplantation, improve bone pain and radiologic signs of osteoporosis in young patients with thalassemia, and reduce bone resorption and pain in children with juvenile rheumatoid arthritis.

Calcitonin is a naturally occurring antiresorptive hormone. Salmon calcitonin is roughly 40 to 50 times more potent than the human-derived form and comes in a nasal spray.

For their study, Dr. Pappa and colleagues randomly assigned 63 children, teens, and young adults with IBD to 200 IU intranasal calcitonin (n = 31) or placebo (n = 32) for 18 months.

Ages ranged from 8 to 21 years. All participants had spinal BMD z-scores at least one standard deviation below the norm, as measured by dual energy x-ray absorptiometry. All received age-appropriate calcium and vitamin D supplements.

Intranasal calcitonin (Miacalcin, Novartis) was well tolerated, with no between-group differences in adverse effects. The most common side effects were epistaxis, irritation of the upper respiratory tract and rhinitis.

However, the intervention didn't seem to be effective. Changes in BMD z-scores at 9 and 18 months did not differ between the calcitonin and the placebo groups. The bone mineral accrual rate during the study did not lead to normalization of BMD z-score.

Intranasal calcitonin did seem to offer a short-term advantage in bone mineral acquisition rate at the spine in Crohn's disease patients. However, this was only a secondary "underpowered" subgroup analysis and the advantage was not sustained. Therefore, more study is needed before firm conclusions can be drawn, the researchers say.

They had hoped the intranasal calcitonin would decrease bone resorption while bone formation recovered or remains stable, allowing for "catch-up" bone mineral accumulation.

But "given that recent research shows that inflammation primarily slows down bone formation in children, we were not surprised that calcitonin, which suppresses bone resorption, did not have a beneficial effect similar to that seen in adults," Dr. Pappa told Reuters Health.

"Children's bones respond differently to inflammation than adults' bones," she said, adding that if antiresorptive medications do have a place in improving bone health, more work will be needed to find it.

The research team did identify several factors favoring higher bone mineral accrual. These include lower baseline BMD and higher baseline body mass index z-score, improvement in height z-score, higher serum albumin, hematocrit and iron concentrations, and more hours of weekly weight-bearing activity.

Factors associated with lower bone mineral accrual included more severe IBD (as indicated by inflammatory markers, need for surgery, hospitalization, and use of immunomodulators) and higher daily caffeine intake.

"This study has shown that measures anabolic to bone such as improved nutrition, exercise, and control of inflammation are more important for bone health improvement in this population," Dr. Pappa said.

Am J Gastroenterol. Published online April 26, 2011. Abstract

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