In fact the glucocorticoid dosage in the treatment of pediatric CD may be not as high as in previous older studies; children with CD often receive enteral nutrition therapy and there are more patients with steroid dependent or refractory course of disease in the low BMD group actually switched earlier to a long-term immunosuppressive therapy including azathioprine, methotrexate and anti-TNF-α antibody treatment. Here, TNF is linked to Cowden disease.