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Article

RANKL/OPG Axis and Bone Mineral Density in Pediatric Inflammatory Bowel Disease

by
Mariusz Olczyk
1,2,*,
Agnieszka Frankowska
1,
Marcin Tkaczyk
1,
Anna Socha-Banasiak
2,
Renata Stawerska
3,
Anna Łupińska
3,
Zuzanna Gaj
4,
Ewa Głowacka
4 and
Elżbieta Czkwianianc
2
1
Department of Paediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, Medical University of Lodz, 90-419 Lodz, Poland
2
Department of Gastroenterology, Allergology and Pediatrics, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
3
Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital-Research Institute, Department of Paediatric Endocrinology, Medical University of Lodz, 93-338 Lodz, Poland
4
Center of Medical Laboratory Diagnostics and Screening, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(15), 5440; https://doi.org/10.3390/jcm14155440 (registering DOI)
Submission received: 30 June 2025 / Revised: 30 July 2025 / Accepted: 31 July 2025 / Published: 1 August 2025
(This article belongs to the Special Issue Inflammatory Bowel Diseases in 2024 and Beyond: From Diagnosis to Treatment)
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Abstract

Background: Inflammatory bowel diseases (IBD), such as Crohn’s disease (CD) and ulcerative colitis (UC), may impair bone metabolism, particularly in children. The RANKL/OPG axis, as a key regulator of bone turnover, may contribute to these disturbances. However, data in the pediatric population remain limited. Methods: A single-center, prospective observational study included 100 children aged 4–18 years, with a comparable number of girls and boys. Among them, 72 had IBD (27 CD, 45 UC) and 28 were healthy controls. Anthropometric, biochemical, and densitometric assessments were performed, including serum levels of RANKL and OPG, and markers of inflammation and bone turnover. Results: Children with CD had significantly lower height and weight percentiles compared to UC and controls. Serum RANKL and the RANKL/OPG ratio were significantly elevated in IBD patients, particularly in CD (p < 0.01). Total body BMD Z-scores were lower in IBD compared to controls (p = 0.03). Low BMD was found in 14.7% of UC and 26.3% of CD patients. In both groups, over 30% had values in the “gray zone” (−1.0 to −2.0). A positive correlation was observed between height and weight and bone density (p < 0.01). Higher OPG was associated with lower body weight (p < 0.001), while increased RANKL correlated with osteocalcin (p = 0.03). Patients receiving biological therapy had significantly lower BMD. Conclusions: Pediatric IBD is associated with significant alterations in the RANKL/OPG axis and reduced bone density. These findings support early screening and suggest RANKL/OPG as a potential biomarker of skeletal health.
Keywords: pediatric inflammatory bowel disease; RANKL/OPG axis; bone metabolism; bone mineral density; ulcerative colitis; Crohn’s disease pediatric inflammatory bowel disease; RANKL/OPG axis; bone metabolism; bone mineral density; ulcerative colitis; Crohn’s disease
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MDPI and ACS Style

Olczyk, M.; Frankowska, A.; Tkaczyk, M.; Socha-Banasiak, A.; Stawerska, R.; Łupińska, A.; Gaj, Z.; Głowacka, E.; Czkwianianc, E. RANKL/OPG Axis and Bone Mineral Density in Pediatric Inflammatory Bowel Disease. J. Clin. Med. 2025, 14, 5440. https://doi.org/10.3390/jcm14155440

AMA Style

Olczyk M, Frankowska A, Tkaczyk M, Socha-Banasiak A, Stawerska R, Łupińska A, Gaj Z, Głowacka E, Czkwianianc E. RANKL/OPG Axis and Bone Mineral Density in Pediatric Inflammatory Bowel Disease. Journal of Clinical Medicine. 2025; 14(15):5440. https://doi.org/10.3390/jcm14155440

Chicago/Turabian Style

Olczyk, Mariusz, Agnieszka Frankowska, Marcin Tkaczyk, Anna Socha-Banasiak, Renata Stawerska, Anna Łupińska, Zuzanna Gaj, Ewa Głowacka, and Elżbieta Czkwianianc. 2025. "RANKL/OPG Axis and Bone Mineral Density in Pediatric Inflammatory Bowel Disease" Journal of Clinical Medicine 14, no. 15: 5440. https://doi.org/10.3390/jcm14155440

APA Style

Olczyk, M., Frankowska, A., Tkaczyk, M., Socha-Banasiak, A., Stawerska, R., Łupińska, A., Gaj, Z., Głowacka, E., & Czkwianianc, E. (2025). RANKL/OPG Axis and Bone Mineral Density in Pediatric Inflammatory Bowel Disease. Journal of Clinical Medicine, 14(15), 5440. https://doi.org/10.3390/jcm14155440

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