Bone Health in Children With Celiac Disease Assessed By Dual X-ray Absorptiometry: Effect of Gluten-free Diet and Predictive Value of Serum Biochemical Indices

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 54; no. 5; pp. 680 - 684
• Main Authors: Margoni, Daphne, Chouliaras, Giorgos, Duscas, Grigoris, Voskaki, Irene, Voutsas, Nikolaos, Papadopoulou, Anna, Panayiotou, Joanna, Roma, Eleftheria
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Copyright by ESPGHAN and NASPGHAN 01.05.2012; Lippincott Williams & Wilkins
• Subjects: Absorptiometry, Photon; Biological and medical sciences; Biomarkers - blood; Bone and Bones - pathology; Bone Density; Celiac Disease - blood; Celiac Disease - diagnosis; Celiac Disease - physiopathology; Child; Child, Preschool; Cross-Sectional Studies; Diet, Gluten-Free; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Osteoarticular system. Muscles; Other diseases. Semiology; Predictive Value of Tests; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin D - administration & dosage; Vitamin D - analogs & derivatives; Human; Immunopathology; Deficient diet; gluten-free diet; Metabolic diseases; Coeliac disease; X ray absorption spectrometry; Diet therapy; Intestinal malabsorption; Gastroenterology; Predictive value; celiac disease; Digestive diseases; Intestinal disease; Serum; Bone mineral density; dual x-ray absorptiometry; Bone; Child; Gluten; bone indices
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/MPG.0b013e31823f5fc5

OBJECTIVES:In the present study, we aimed to assess bone status and the effect of gluten-free diet (GFD) in children with celiac disease (CD), and to evaluate the predictive value of standard serum biochemical indices in the diagnosis of bone mineral density (BMD) disturbances. METHODS:Forty-five children at the time of diagnosis of CD (group A, 77.8% girls) and 36 children receiving GFD for >2 years (group B, 75% girls) were included. Sixteen children in group A were reexamined 12 months after initiation of GFD. Serum measurements of biochemical bone health indices and BMD, assessed by dual x-ray absorptiometry, were obtained. RESULTS:Patients after 1 year of receiving GFD had higher BMD z scores compared with baseline (−1.45 ± 0.28 vs −0.61 ± 0.25, respectively, P = 0.004). BMD z scores were significantly lower than expected for the normal population, after 1 (P = 0.03) or at least 2 (P < 0.001) years of receiving GFD. In group B, BMD z score was positively correlated with 25-hydroxy vitamin D levels (P = 0.009). In the repeated measurements group, 25-hydroxy vitamin D differed between pre- and post-GFD (P = 0.018). No biochemical index was capable of predicting an abnormal BMD z score (receiver operating characteristic curve analysis, all of the areas under the curve <0.66). CONCLUSIONS:GFD has a beneficial effect on bone health. Two years receiving diet do not ensure normalization. Biochemical markers are not indicative of BMD disturbances. Dual x-ray absorptiometry should be included in the standard management of children with CD.