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
Journal of Pediatric Gastroenterology and Nutrition,

Margoni D et al. – Gluten–free diet (GFD) has a beneficial effect on bone health. Two years receiving diet do not ensure normalization. Biochemical markers are not indicative of bone mineral density (BMD) disturbances. Dual x–ray absorptiometry should be included in the standard management of children with CD.

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. 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).

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