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11 November 2026

13 Pages

Changes in Growth Indices and Bone Mineral Density After Infliximab Therapy in Steroid-Naive Pediatric Crohn’s Disease: A Single-Center Retrospective Study

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1
Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
2
Department of Pediatrics, Korea University Medical Center Anam Hospital, Seoul 02841, Republic of Korea
3
Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
*
Author to whom correspondence should be addressed.
Children2026, 13(11), 1569;https://doi.org/10.3390/children13111569
This article belongs to the Special Issue Pediatric Inflammatory Bowel Diseases: Epidemiology, Pathogenesis, Diagnosis, and Novel Treatment Approaches
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Highlights

What are the main findings?
  • In steroid-naive pediatric patients with Crohn’s disease who started infliximab within 6 months of diagnosis, combination therapy with immunomodulators was associated with improved disease activity, inflammatory markers, and growth-related parameters.
  • Height velocity improved in patients with remaining growth potential, especially at a bone age below 12 years, whereas bone mineral density changes were not significant overall after correction for multiple comparisons.
What are the implications of the main findings?
  • Steroid-free infliximab-based therapy started within 6 months of diagnosis may support growth and nutritional recovery in children with Crohn’s disease, especially before skeletal maturation is advanced.
  • Longer-term controlled studies are needed to determine whether these early gains translate into improved adult height and sustained skeletal benefits.

Abstract

Background/Objectives: In children, Crohn’s disease (CD) can impair linear growth and skeletal mineralization, resulting in reduced bone mineral density (BMD). We evaluated changes in growth indices and BMD following infliximab (IFX) therapy combined with immunomodulators in pediatric CD. Methods: This single-center retrospective study included 35 steroid-naive pediatric patients with CD who initiated IFX within 6 months of diagnosis between 2020 and 2025. Changes in inflammatory markers, growth indices, and BMD were assessed from baseline to 1 year after IFX initiation. Results: After 1 year of IFX therapy, inflammatory markers and clinical disease activity improved significantly. Weight and body mass index z-scores, insulin-like growth factor 1 (IGF-1) z-score, and vitamin D levels increased significantly. Femoral neck BMD z-score increased, although the increase did not remain statistically significant after correction for multiple comparisons. Lumbar spine BMD z-score showed no significant change. Conclusions: In steroid-naive pediatric patients with CD who started IFX within 6 months of diagnosis, IFX-based therapy was associated with improved inflammatory activity and growth-related parameters. These findings suggest the potential value of such therapy in supporting growth and nutritional recovery, whereas its effects on skeletal health require confirmation in longer-term controlled studies.

1. Introduction

Crohn’s disease (CD) is a form of inflammatory bowel disease (IBD) characterized by chronic transmural inflammation that may involve any segment of the gastrointestinal tract; its pathogenesis reflects an interplay of genetic susceptibility, environmental triggers, and dysregulated immunity [1]. About one in four individuals with IBD develops the disease before the age of 20 years [2]. Pediatric-onset CD is becoming more common globally, with incidence estimates of 2.5–11.4 per 100,000; Korean data show a rise to 2.7–3.8 per 100,000, which has been linked in part to the adoption of Western dietary patterns [3,4].
Children with CD commonly experience chronic diarrhea, abdominal pain, and weight loss, and may also develop extraintestinal complications such as impaired linear growth and reduced bone mineral density (BMD) [5,6,7,8]. Because childhood and adolescence are critical periods for growth and bone development, malnutrition, elevated inflammatory cytokines, and prolonged corticosteroid use in CD can adversely affect growth and bone health [9,10].
Therapeutic options for pediatric CD comprise exclusive enteral nutrition, corticosteroids, aminosalicylates, immunomodulators, antibiotics, and anti-tumor necrosis factor (anti-TNF) agents [11]. Corticosteroids have traditionally been used to induce remission, but prolonged exposure carries risks such as growth retardation, low BMD, serious infections, and Cushing’s syndrome [12,13]. Infliximab (IFX), a monoclonal antibody against TNF-α, is recommended as a first-line biologic for children whose moderate-to-severe disease fails to respond to conventional treatment or who are at high risk of a complicated course [11,14]. A top-down strategy combining IFX with immunomodulators has shown greater efficacy and fewer adverse effects than conventional step-up therapy [12,15,16]. However, the timing of biologic initiation varies across studies, and prior corticosteroid exposure can confound the assessment of bone and growth recovery.
Evaluating IFX specifically in corticosteroid-naive patients helps reduce confounding from steroid-induced bone toxicity. Although studies have examined BMD changes after IFX [17,18], few have focused on a biologic-first approach in patients without prior corticosteroid exposure. Therefore, we investigated longitudinal changes in BMD and growth indices from baseline (before IFX initiation) to 1 year after IFX initiation in Korean children and adolescents with CD who started IFX within 6 months of diagnosis without steroid therapy. We further evaluated whether the growth response to IFX therapy varied with skeletal maturity and remaining growth potential at treatment initiation.

2. Materials and Methods

2.1. Patients

We retrospectively reviewed 222 patients aged 10–18 years who were treated with IFX for CD at Kyungpook National University Children’s Hospital from January 2020 to August 2025. Of these, 35 had BMD measured both at baseline (before IFX initiation) and 1 year after IFX initiation and formed the study cohort. In every case, IFX was started within 6 months of CD diagnosis, and no patient received corticosteroids at any time, either before IFX initiation or throughout the study period. All diagnoses fulfilled the revised Porto criteria of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) [19]. Induction consisted of intravenous IFX (5 mg/kg) at weeks 0, 2, and 6, with the same dose repeated every 8 weeks for maintenance, in line with pediatric CD guidelines [11]. Concomitant medications, including azathioprine, mesalamine, and oral metronidazole, were used as clinically indicated; methotrexate was added when necessary. Patients with baseline serum 25-hydroxyvitamin D (25(OH)D) levels < 20.0 ng/mL received vitamin D supplementation at 1000 IU/day.

2.2. Definitions and Study Flow

Baseline demographic and clinical characteristics, including age, sex, concomitant medications, surgical history, vitamin D supplementation, and history of osteoporotic fractures, were extracted from medical records. To evaluate treatment response, clinical and endoscopic disease activity, inflammatory and biochemical markers, and fecal calprotectin were compared between baseline (before IFX initiation) and 1 year after IFX initiation. Clinical activity was scored with the Pediatric Crohn’s Disease Activity Index (PCDAI) [20], and mucosal inflammation was graded with the Simple Endoscopic Score for Crohn’s Disease (SES-CD) [21]. A serum 25(OH)D concentration < 20.0 ng/mL was regarded as vitamin D deficiency [22].
Growth and skeletal outcomes included changes in height, weight, and body mass index (BMI) z-scores, height velocity, insulin-like growth factor 1 (IGF-1) z-score, predicted adult height (PAH), and BMD z-scores at the femoral neck and lumbar spine from baseline to 1 year after IFX initiation. Anthropometric z-scores were calculated with reference to the 2017 Korean National Growth Charts [23]. Short stature was defined as a height z-score < −2.0. Bone age was assessed using the Greulich–Pyle atlas [24], and IGF-1 levels were standardized against 2012 Korean pediatric reference values [25]. PAH was estimated using the Bayley–Pinneau method [26]. BMD at the femoral neck and lumbar spine (L1–L4) was measured using dual-energy X-ray absorptiometry (DXA; Horizon, Hologic Inc., Marlborough, MA, USA) [27]. Because DXA measures areal BMD, BMD values were expressed as z-scores using age- and sex-matched Korean reference data, and low BMD for chronological age was defined as an areal BMD z-score of ≤−2.0, in accordance with the 2013 International Society for Clinical Densitometry Pediatric Official Positions [28,29].
For growth- and bone-related analyses, patients with bone age at diagnosis at or above the mean age of growth completion according to Korean longitudinal growth standards (girls, ≥15 years; boys, ≥17 years) [30] were classified as having completed growth and excluded from these analyses. Height velocity analyses were restricted to patients with at least 12 months of documented pre-treatment height measurements to minimize the influence of seasonal variation and measurement error [31,32]. Patients without 12 months of pre-treatment height records remained eligible for other growth- and bone-related analyses. Height velocity z-scores were derived from the age- and sex-specific Korean longitudinal references of the Kangwha Study [30], applying the midpoint age of each measurement interval and interpolating linearly between annual reference values.
To examine potential selection bias associated with the need for at least 12 months of pre-treatment height records, we compared baseline characteristics of patients who did and did not have evaluable height velocity. As a sensitivity analysis, we repeated the height velocity analysis in all patients with available height velocity data regardless of bone age or the duration of pre-treatment height records.

2.3. Statistical Analysis

Data are presented as mean ± standard deviation (SD) or median (interquartile range (IQR): 25th–75th percentiles). Pre- and post-treatment values were compared with paired t-tests for continuous variables and with McNemar’s test or Bowker’s test of symmetry for categorical variables. Patients with and without evaluable height velocity were compared using the Mann–Whitney U test (continuous variables) and Fisher’s exact test (categorical variables). Pearson’s correlation was used to examine associations between continuous variables, including exploratory analyses of changes in serum 25(OH)D against changes in femoral neck and lumbar spine BMD z-scores. Because BMD was compared at two sites, Bonferroni-adjusted p-values were also calculated to check the robustness of these findings. A two-sided p < 0.05 indicated statistical significance. All analyses were conducted in SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA).

3. Results

Of the 35 patients, 23 (65.7%) were male and 12 (34.3%) were female. Median chronological age at diagnosis was 12.4 years (IQR, 11.6–14.9), and median bone age was 12.7 years (11.2–16.1). All patients received azathioprine and mesalamine; one (2.9%) also received methotrexate, and 29 (82.9%) received oral metronidazole. Surgical intervention for perianal manifestations was performed in 88.6% (31/35) of patients. Vitamin D supplementation was given to 32 patients (91.4%); the three patients who did not receive supplementation had baseline 25(OH)D levels ≥ 20.0 ng/mL. The mean duration of vitamin D supplementation was 1.20 ± 0.24 years. No osteoporotic fractures occurred during the study period. Table 1 presents the baseline characteristics.
Table 1. Baseline demographics and clinical characteristics of the study cohort (n = 35).
Clinical, endoscopic, and laboratory measures of CD activity improved from baseline to 1 year after IFX therapy (Table 2). PCDAI scores decreased significantly from 45.7 ± 17.9 at baseline to 3.6 ± 7.4 after 1 year of IFX therapy (p < 0.001). PCDAI scores were classified as moderate-to-severe, mild, or inactive. The proportion of patients in moderate-to-severe and mild categories decreased from 77.1% (27/35) and 20.0% (7/35), respectively, at baseline to 2.9% (1/35) after 1 year of therapy, whereas the inactive proportion increased from 2.9% (1/35) at baseline to 94.3% (33/35) after therapy. After therapy, 92.6% (25/27) of moderate-to-severe patients, 100% (7/7) of mild patients, and 100% (1/1) of inactive patients shifted to the inactive category; these differences were significant by Bowker’s test of symmetry (p < 0.001). Likewise, the SES-CD decreased significantly from 15.7 ± 8.9 at baseline to 1.8 ± 3.2 after 1 year of therapy (p < 0.001). Fecal calprotectin, erythrocyte sedimentation rate, C-reactive protein, white blood cell count, hematocrit, platelet count, and serum albumin levels also changed significantly after treatment (p < 0.001).
Table 2. Clinical, endoscopic, and laboratory measures at baseline and after 1 year of IFX therapy.
We next examined vitamin D status and related biomarkers before and after treatment. At baseline (before IFX initiation), mean 25(OH)D level was 17.69 ± 9.06 ng/mL, with 71.4% (25/35) of patients classified as vitamin D deficient (Table 3). 25(OH)D levels were not significantly associated with PCDAI scores (r = −0.093, p = 0.595). After 1 year of IFX therapy and vitamin D supplementation, mean 25(OH)D levels increased significantly to 28.54 ± 8.51 ng/mL, and vitamin D deficiency persisted in 14.3% (5/35) of patients (p < 0.001).
Table 3. Growth-related parameters, vitamin D status, and BMD at baseline and after 1 year of IFX therapy.
Mean calcium, albumin, and phosphorus levels were within reference ranges. Calcium level showed no significant association with either PCDAI scores or 25(OH)D level (r = −0.262, p = 0.128; r = 0.093, p = 0.595, respectively), although it correlated positively with albumin level (r = 0.570, p < 0.001). After therapy, calcium and albumin levels increased significantly but remained within reference ranges (p = 0.003 and p < 0.001), while phosphorus levels remained unchanged (p = 0.950).
Table 3 shows BMD changes at the femoral neck and lumbar spine (L1–L4). At baseline (before IFX initiation), mean femoral neck and lumbar spine BMD z-scores were −1.15 ± 1.00 and −0.39 ± 1.00, respectively. Femoral neck BMD z-score was not significantly correlated with PCDAI score, IGF-1 z-score, or 25(OH)D level (r = 0.001, p = 0.994; r = −0.115, p = 0.512; r = −0.201, p = 0.248, respectively), but was positively correlated with calcium level (r = 0.428, p = 0.01). Lumbar spine BMD z-score did not correlate significantly with PCDAI score (r = 0.129, p = 0.459), IGF-1 z-score, 25(OH)D level (r = −0.162, p = 0.352), or calcium level (r = 0.084, p = 0.630). After 1 year of therapy, femoral neck BMD z-score increased from −1.15 ± 1.00 to −0.83 ± 1.13 (unadjusted p = 0.037), but the change did not remain statistically significant after Bonferroni correction for the two BMD outcomes (adjusted p = 0.074). Lumbar spine BMD z-score did not change significantly (unadjusted p = 0.214). The proportion of patients classified as having a BMD z-score ≤−2.0 at either site decreased from 22.9% (8/35) at baseline to 14.3% (5/35) after therapy; this reduction did not reach statistical significance (p = 0.508). In an additional exploratory analysis, changes in serum 25(OH)D levels were not significantly correlated with changes in femoral neck BMD z-scores (r = −0.027, p = 0.879) or lumbar spine BMD z-scores (r = −0.115, p = 0.509).
To focus on patients with remaining growth potential, we repeated the analyses after excluding eight patients whose bone age at diagnosis met the threshold for growth completion according to Korean longitudinal standards (≥15 years in girls and ≥17 years in boys) (Table 4). In the remaining 27 patients (18 boys, 9 girls; mean age at diagnosis, 12.2 ± 1.4 years), femoral neck BMD z-score increased from −1.28 ± 0.98 to −0.82 ± 1.15 (unadjusted p = 0.010; Bonferroni-adjusted p = 0.020), whereas lumbar spine BMD z-score did not change significantly (unadjusted p = 0.325). Height velocity was evaluable in 18 of these patients with at least 12 months of documented pre-treatment height measurements. Height velocity increased from 3.31 ± 1.80 to 6.14 ± 3.07 cm/year (p = 0.004), and height velocity z-score improved from −1.61 ± 1.24 to 0.39 ± 1.09 (p < 0.001). Weight, BMI, and IGF-1 z-scores also improved (all p < 0.001), whereas height z-score (p = 0.148) and PAH (p = 0.323) did not change significantly. In a sensitivity analysis, the improvement in height velocity z-score remained significant when all 32 patients with available height velocity data were included regardless of bone age or record length (−1.25 ± 1.24 to 0.04 ± 0.98, p < 0.001). Patients with evaluable height velocity had lower baseline height, weight, and BMI z-scores and a lower bone age than those without (Table A1).
Table 4. Growth-related parameters and BMD at baseline and after 1 year of IFX therapy in patients with remaining growth potential (n = 27).
The magnitude of improvement varied according to skeletal maturity (Table 5). In patients with a bone age below 12 years, height velocity z-score (2.26 ± 1.54, p = 0.001), IGF-1 z-score (0.96 ± 1.03, p = 0.008), and femoral neck BMD z-score (0.60 ± 0.87, p = 0.037) improved significantly. At a bone age of 12 to <14 years, weight, BMI, and IGF-1 z-scores improved significantly, with nonsignificant increases in height velocity z-score (2.03 ± 1.74, p = 0.060) and femoral neck BMD z-score (0.50 ± 0.81, p = 0.067), whereas no parameter improved significantly at a bone age of 14 years or above. These exploratory subgroup analyses showed larger improvements in growth- and bone-related parameters among patients with less advanced skeletal maturation.
Table 5. Changes in growth and bone parameters after IFX therapy according to baseline bone age (n = 27).

4. Discussion

In this steroid-naive pediatric CD cohort, IFX-based therapy was associated with significant reductions in disease activity and improvements in nutritional and growth-related parameters over 1 year. These improvements were evident in weight, BMI, and IGF-1 z-scores, whereas height z-score and PAH did not change significantly. Height velocity also increased after treatment in the subgroup with remaining growth potential and evaluable pre-treatment data. Femoral neck BMD z-score increased numerically, but this change did not remain statistically significant after Bonferroni correction. Lumbar spine BMD z-score did not change significantly. These findings suggest that early nutritional and metabolic recovery may be accompanied by improvements in linear growth velocity, although measurable gains in height z-score and PAH were not observed during the 1-year study period, and the bone findings remain exploratory.
The growth response to IFX therapy in this cohort appeared to be closely associated with recovery of nutritional status and the IGF-1 axis, with the extent of linear growth recovery varying according to skeletal maturity at treatment initiation. Growth impairment in pediatric CD is attributed in part to elevated inflammatory cytokine levels, including TNF-α and interleukin-6 levels, which can increase growth hormone resistance and reduce IGF-1 concentrations [10,33]. After IFX therapy, weight, BMI, and IGF-1 z-scores increased significantly, consistent with improvements in nutritional status and reduced inflammatory activity. However, these improvements were not accompanied by significant changes in height z-score or PAH. A previous study reported that IFX treatment initiated within 1 month after diagnosis significantly increased height z-scores compared with conventional step-up therapy [16]. In our cohort, the median bone age of 12.7 years at baseline suggests that some patients may have had limited remaining growth potential at treatment initiation, potentially attenuating the magnitude of linear growth recovery. Among patients with remaining growth potential and evaluable pre-treatment growth data, height velocity increased from 3.31 to 6.14 cm/year, consistent with recovery of linear growth. Exploratory subgroup analyses showed significant improvements in height velocity z-score among patients with a baseline bone age below 12 years, whereas no statistically significant improvement was observed in those with more advanced skeletal maturation. These findings suggest that recovery of linear growth velocity may not necessarily translate into measurable improvements in height z-score or PAH within a relatively short follow-up period. Extended follow-up will be needed to establish whether this early recovery leads to sustained gains in linear growth and final adult height, particularly in children with less advanced skeletal maturation and greater remaining growth potential.
BMD, the other main outcome of this study, showed different patterns of change at the femoral neck and lumbar spine during IFX-based therapy. Although femoral neck BMD z-score increased, this finding should be interpreted as exploratory because it did not remain statistically significant after correction for multiple comparisons. A numerically larger increase was observed after excluding patients who had completed growth (Bonferroni-adjusted p = 0.020), although this subgroup finding requires confirmation. Exploratory subgroup analyses suggested a larger increase among patients with a baseline bone age below 12 years. The difference between sites may reflect a site-specific response, but this requires confirmation in further studies.
Previous studies have also reported BMD changes during anti-TNF therapy. Among adults with CD, treatment with anti-TNF agents such as IFX has been linked to significant BMD gains at several skeletal sites, among them the lumbar spine and femoral neck [34]. In randomized and long-term follow-up studies, IFX-treated patients showed significant gains in lumbar spine and femoral neck BMD from baseline that exceeded those achieved with conventional steroid-based regimens [35]. In pediatric CD, impaired bone health has been documented consistently [36], although longitudinal data based on direct BMD measurements remain limited. Previous pediatric studies have demonstrated improvements in trabecular BMD and cortical bone structure following anti-TNF therapy, suggesting that suppression of inflammation may promote skeletal recovery [17,18]. A site-specific pattern has also been reported in pediatric CD, in which anti-TNF therapy improved femoral neck and total hip BMD while lumbar spine areal BMD remained unchanged [17]. This pattern may partly reflect limitations of posteroanterior spine DXA, in which superimposition of cortical bone in the posterior elements may reduce sensitivity to treatment-related changes in vertebral trabecular bone [17]. Therefore, limited DXA sensitivity to changes in vertebral trabecular bone may have contributed to the absence of a significant change in lumbar spine BMD in our cohort, while the relatively short follow-up period may also have limited our ability to detect changes in BMD over time. Importantly, although previous studies have demonstrated improvements in bone health following anti-TNF therapy in pediatric CD [17,18], some included patients with corticosteroid exposure, which may have influenced BMD outcomes. In contrast, our cohort received no corticosteroids either before or during follow-up, which minimized potential confounding from corticosteroid exposure when evaluating BMD changes during IFX-based therapy. In this steroid-free setting, BMD did not deteriorate at either site and femoral neck BMD z-score increased, suggesting that an early steroid-free, IFX-based approach may help preserve bone health during disease control.
Concurrent vitamin D supplementation should also be considered when interpreting the femoral neck BMD findings. Most patients (91.4%) received vitamin D supplementation during follow-up, and the prevalence of vitamin D deficiency decreased from 71.4% to 14.3%. Because vitamin D repletion enhances intestinal calcium absorption and bone mineralization, correction of vitamin D deficiency may have contributed to the observed increase in femoral neck BMD. In an exploratory analysis, changes in serum 25(OH)D levels were not significantly correlated with changes in femoral neck or lumbar spine BMD z-scores; however, given the small sample size, this finding does not exclude a contribution from vitamin D replacement. Without a concurrent control group, a causal effect of IFX on BMD cannot be established, and its effects, including those mediated by reduced inflammation, cannot be distinguished from those of vitamin D supplementation and nutritional recovery.
This study has several limitations. First, the data came from a single institution, were collected retrospectively, and involved only 35 patients followed for 1 year; moreover, the absence of a comparison group limits causal inference and generalizability. Type II errors cannot be excluded for the nonsignificant changes in lumbar spine BMD and height z-scores. Second, the primary height velocity analysis was restricted to patients with at least 12 months of documented pre-treatment height measurements. These patients had lower baseline height, weight, and BMI z-scores and less advanced skeletal maturation than those without such records (Table A1), and therefore had greater potential for catch-up growth; their poorer baseline growth also raises the possibility that part of the observed improvement reflects regression toward the mean. Although a sensitivity analysis including all 32 patients with available pre-treatment height velocity data showed a consistent improvement in height velocity z-score, this analysis cannot eliminate selection bias, and the height velocity findings should be interpreted with caution. Third, most patients concurrently received vitamin D supplementation and experienced nutritional recovery, both of which may have contributed to the observed changes in growth and BMD; therefore, the effects of IFX could not be isolated. Future multicenter, prospective, controlled studies with larger sample sizes and longer follow-up periods are needed to confirm these observations and determine whether the improvements in growth velocity and bone health translate into sustained long-term benefits.

5. Conclusions

In conclusion, in steroid-naive pediatric patients with CD in whom IFX was initiated within 6 months of diagnosis, IFX-based therapy over 1 year was associated with improved height velocity in those with remaining growth potential, although height z-score did not change significantly. These changes were accompanied by reduced disease activity and improvements in weight, BMI, and IGF-1 z-scores. Although femoral neck BMD z-score increased numerically, further studies are needed to determine whether IFX-based therapy provides sustained benefits for skeletal health. Our findings suggest the potential value of initiating IFX-based therapy within 6 months of diagnosis in supporting growth and nutritional recovery in children with CD.

Author Contributions

Conceptualization, N.K. and J.-E.M.; methodology, N.K., S.L., and K.J.; software, S.L. and S.C.; validation, K.J. and B.-H.C.; formal analysis, N.K., Y.L., K.J., and J.-E.M.; data curation, N.K. and Y.L.; writing—original draft preparation, N.K. and Y.L.; writing—review and editing, B.-H.C. and J.-E.M.; visualization, N.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The Institutional Review Board of Kyungpook National University Chilgok Hospital approved the study (KNUCH 2025-02-012; Date of Approval: 27 February 2025).

Data Availability Statement

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. The data are not publicly available because they contain sensitive medical information of pediatric patients, and public sharing is restricted to protect patient privacy in accordance with institutional ethical regulations.

Acknowledgments

The authors thank the patients who contributed to this study. We also thank the clinical staff of Kyungpook National University Children’s Hospital for their dedicated care of these children.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
CDCrohn’s disease
IFXInfliximab
BMDBone mineral density
PCDAIPediatric Crohn’s Disease Activity Index
IGF-1Insulin-like growth factor 1
IBDInflammatory bowel disease
anti-TNFAnti-tumor necrosis factor
ESPGHANEuropean Society for Paediatric Gastroenterology, Hepatology and Nutrition
25(OH)D25-hydroxyvitamin D
SES-CDSimple Endoscopic Score for Crohn’s Disease
BMIBody mass index
PAHPredicted adult height
IQRInterquartile range
ESRErythrocyte sedimentation rate
CRPC-reactive protein
WBCWhite blood cell

Appendix A

Table A1. Baseline characteristics of patients with remaining growth potential (n = 27) according to height velocity evaluability.

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