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Bone Mineral Density in Celiac Disease

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Abstract

Objectives

To study bone mineral density (BMD) and standard serum biochemical indices among newly diagnosed and already diagnosed cases of Celiac Disease (CD) on gluten free diet for at least one year.

Methods

This hospital based analytic, observational study was done at a tertiary care centre, from April 2013 through June 2014. Thirty six children (20 females) with untreated CD at diagnosis (Group A) and 36 age and sex matched children on gluten-free diet for at least one year (Group B) were studied. Serum measurements of biochemical bone health indices and BMD, assessed by dual X-ray absorptiometry, were obtained.

Results

BMD Z-score was significantly low in newly diagnosed celiac patients. Patients on gluten free diet had higher BMD Z-score as compared to newly diagnosed patients (−2.02 vs. −0.65 respectively, p < 0.001). BMD Z-score was high in GI symptom patients as compared to non-GI symptom patients (−0.46+/−0.89 vs. − 0.88 = +/−0.94) in Group B. In female patients BMD Z-score was comparatively low as compared to male patients in both groups but difference was not significant. In Group A the mean serum calcium level was lower than the patients in Group B (8.72 + 0.73 vs. 9.34 + 0.65, p < 0.001). S. calcium levels were not correlated with bone mineral density (BMD) in both groups (P value >0.05).

Conclusions

Children with CD are at risk for reduced BMD. Strict gluten-free diet significantly improves bone mineralization. Early diagnosis and treatment of celiac disease during childhood may protect CD patients from osteoporosis.

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References

  1. Husby S, Koletzko S, Korponay-Szabó IR, et al; ESPGHAN Working Group on Coeliac Dsease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of celiac disease. J Pediatr Gastroenterol Nutr. 2012;54:136–60.

  2. Branski D, Troncone R. Gluten sensitive enteropathy (celiac disease). In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier Saunders; 2011. p. 1308–11.

  3. Lionetti E, Catassi C. New clues in celiac disease epidemiology, pathogenesis, clinical manifestations and treatment. Int Rev Immunol. 2011;30:219–31.

    Article  PubMed  Google Scholar 

  4. Tiziana L, Evelina S, Immacolata N, Ludovico A, Maria I, Francesco L. Bone mineralization in celiac disease. Gastroenterol Res Pract. 2012; Article ID 198025 doi:10.1155/2012/198025.

  5. Krupa-Kozak U. Pathologic bone alterations in celiac disease: etiology, epidemiology,and treatment. Nutrition. 2014;30:16–24.

    Article  CAS  PubMed  Google Scholar 

  6. Binkovitz LA, Henwood MJ. Pediatric DXA: technique and interpretation. Pediatr Radiol. 2007;37:21–31.

  7. Blake GM, Fogelman I. Interpretation of bone densitometry studies. Semin Nucl Med. 1997;27:248–60.

    Article  CAS  PubMed  Google Scholar 

  8. Kagnoff MF. Overview and pathogenesis of celiac disease. Gastroenterology. 2005;128:S10–8.

    Article  CAS  PubMed  Google Scholar 

  9. Szathmari M, Tulassay T, Arato A, Bodánszky H, Szabó A, Tulassay Z. Bone mineral content and density in asymptomatic children with coeliac disease on a gluten free diet. Eur J Gastroenterol Hepatol. 2001;13:419–24.

    Article  CAS  PubMed  Google Scholar 

  10. Kavak US, Yuce A, Kocak N, et al. Bone mineral density in children with untreated and treated celiac disease. J Pediatr Gastroenterol Nutr. 2003;37:434–6.

  11. Molteni N, Caraceni MP, Bardella MT, Ortolani S, Gandolini GG, Bianchi P. Bone mineral density in adult celiac patients and effect of gluten free diet from childhood. Am J Gastroenterol. 1990;85:51–3.

    CAS  PubMed  Google Scholar 

  12. Mora S, Barera G, Ricotti A, Weber G, Bianchi C, Chiumello G. Reversal of low bone density with a gluten-free diet in children and adolescents with celiac disease. Am J Clin Nutr. 1998;67:477–81.

    CAS  PubMed  Google Scholar 

  13. Kalayci AG, Kansu A, Girgin N, Kucuk O, Aras G. Bone mineral density and importance of a gluten-free diet in patients with celiac disease in childhood. Pediatrics. 2001;108:E89.

    Article  CAS  PubMed  Google Scholar 

  14. Mora S, Barera G, Beccio S, et al. A prospective, longitudinal study of the long-term effect of treatment on bone density in children with celiac disease. J Pediatr. 2001;139:516–21.

    Article  CAS  PubMed  Google Scholar 

  15. Barera G, Beccio S, Proverbio MC, Mora S. Longitudinal changes in bone metabolism and bone mineral content in children with celiac disease during consumption of a gluten-free diet. Am J Clin Nutr. 2004;79:148–54.

    CAS  PubMed  Google Scholar 

  16. Sdepanian VL, Miranda Carvalho CN, de Morais MB, Colugnati FA, Fagundes-Neto U. Bone mineral density of the lumbar spine in children and adolescents with celiac disease on a gluten-free diet in Sao Paulo, Brazil. J Pediatr Gastroenterol Nutr. 2003;37:571–6.

    Article  CAS  PubMed  Google Scholar 

  17. Tau C, Mautalen C, De Rosa S, Roca A, Valenzuela X. Bone mineral density in children with celiac disease: effect of a gluten-free diet. Eur J Clin Nutr. 2006;60:358–63.

    Article  CAS  PubMed  Google Scholar 

  18. Heyman R, Guggenbuhl P, Corbel A, et al. Effect of a gluten-free diet on bone mineral density in children with celiac disease. Gastroenterol Clin Biol. 2009;33:109–14.

    Article  CAS  PubMed  Google Scholar 

  19. Motta ME, Faria ME, Silva GA. Prevalence of low bone mineral density in children and adolescents with celiac disease under treatment. Sao Paulo Med J. 2009;127:278–82.

    Article  PubMed  Google Scholar 

  20. Blazina S, Bratanic N, Campa AS, Blagus R, Orel R. Bone mineral density and importance of strict gluten-free diet in children and adolescents with celiac disease. Bone. 2010;47:598–603.

    Article  PubMed  Google Scholar 

  21. Margoni D, Chouliaras G, Duscas G, et al. Bone health in children with celiac disease assessed by dual x-ray absorptiometry: effect of gluten-free diet and predictive value of serumbiochemical indices. J Pediatr Gastroenterol Nutr. 2012;54:680–4.

    Article  CAS  PubMed  Google Scholar 

  22. Stefano P, Massimo L, Alessandro A, et al. Bone mineral density at diagnosis of celiac disease and after 1 year of gluten-free diet. Sci World J. 2014; Article ID 173082. doi:10.1155/2014/173082.

  23. Garg K, Gupta RK. What a practitioner needs to know about celiac disease? Indian J Pediatr. 2015;82:145–51.

    Article  PubMed  Google Scholar 

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Contributions

GC collected data and drafted the manuscript; RKG designed the study, prepared the manuscript and will act as guarantor for the paper. GC and RKG did literature search. JB helped in data collection and statistical analysis.

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Correspondence to Raj Kumar Gupta.

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Choudhary, G., Gupta, R.K. & Beniwal, J. Bone Mineral Density in Celiac Disease. Indian J Pediatr 84, 344–348 (2017). https://doi.org/10.1007/s12098-016-2273-1

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  • DOI: https://doi.org/10.1007/s12098-016-2273-1

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