SAT-728 Bone Mineral Density Challenges In Pediatric And Young Adults With Eosinophilic Esophagitis: A Closer Look At Risks And Insights.

Abstract Disclosure: S.S. Chugh: None. U.A. Khawaja: None. B.H. Barnes: Sanofi, Regeneron Pharmaceuticals. E.C. McGowan: Takeda, Bristol-Myers Squibb, AstraZeneca, Regeneron Pharmaceuticals, Sanofi. M. Misra: None. Background: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease characterized by eosinophil-predominant inflammation (≥15 eosinophils per high-power field) and esophageal dysfunction. It frequently coexists with atopic conditions, and has a male predominance. Chronic inflammation is known to impact bone health deleteriously in other conditions. The goal of this study was to evaluate the impact of EoE on bone mineral density (BMD) in pediatric and young adult patients, and to identify key risk factors associated with low BMD. Methods: This study was approved by our Institutional Review Board (IRB). A retrospective chart review was conducted for 123 patients with EoE, aged 5–25 years (98 males, 25 females), who underwent dual-energy X-ray absorptiometry (DXA) for BMD assessment. 103 patients were younger than 18 years, and 20 were 18 years or older. Data were collected from electronic medical records spanning January 2020, to January 2025 (60 months). Data management was performed using REDCap, and statistical analysis using JMP Pro 18.0.2. Results: Patients with EoE had a median age of 11.3 years (IQR: 9–16) and median disease duration of 47 months (IQR: 20–77). The median BMI was 19.0 (IQR: 17–22) kg/m2, and BMI z-score (BMIz) 0.48 (IQR: -0.54 to 1.34).Hip BMD Z-scores (n=76) had a median of -0.67 (IQR: -1.59 to 0.26), with 37% below -1 SD and 16% below -2 SD. Spine BMD Z-scores (n=105) had a median of -0.48 (IQR: -1.16 to 0.38), with 30% below -1 SD and 12% below -2 SD. Total body less head BMD Z-scores (n=44) had a median of -0.82 (IQR: -1.69 to 0.25), with 45% below -1 SD and 21% below -2 SD.In a multivariate model that included age, sex, BMIz, duration since diagnosis, and whether or not EoE had remitted, associations were identified of (i) hip BMD Z-scores with BMIz (p = 0.016), sex (p = 0.004) and age (p=0.004), (ii) spine BMD Z-scores with BMIz (p<0.0001), and (iii) total bod y less head BMD Z-scores with BMIz (p=0.004). 25OHD levels were not associated with BMD Z-scores.Males had lower BMD Z-scores than females at both the hip (p = 0.001) and spine (p = 0.021), underscoring sex-based differences in bone health. A larger proportion of males vs. females had a diagnosis of autism (18.4% vs. 4.0%, p=0.045), a known risk factor for low BMD, but a diagnosis of autism was not independently associated with BMD Z-scores. Conclusions: Patients with EoE exhibited a high prevalence of low BMD, particularly at the hip and spine, with significant sex-based differences. BMIz was the strongest predictor of BMD across all sites, and males had lower BMD than females. These findings emphasize the need for early BMD screening and targeted interventions to mitigate long-term skeletal risks in this population. Further research is warranted to explore the longitudinal impact of EoE-related factors on bone health and to develop preventive strategies. Presentation: Saturday, July 12, 2025