Bone mineral density in children with celiac disease. Effect of a Gluten-free diet

Objective: To assess the degree of osteopenia in children with celiac disease ( CD) at the time of diagnosis and the effect of a gluten-free diet (GFD). Design: Longitudinal and prospective study. Subjets: In total, 24 children ( 18 girls, six boys) diagnosed with CD by means of an intestinal biopsy were included in the study. Mean +/- s. d. age was 4.9 +/- 4.3 years. In all, 16 patients were under (2.20 +/- 0.82 year) and eight were over the age of 4 years (10.30 +/- 2.90 year). The time between the first symptoms and diagnosis was 17.30 +/- 24.70 months ( range: 2 - 109 months). Spine bone mineral content (BMC), area and bone mineral density (BMD) were measured by DXA at baseline and 1.17 +/- 0.93 years after GFD. Results: Before treatment, mean +/- s. d. BMD was 0.46 +/- 0.13 g/cm(2), the BMD Z-score was - 1.36 +/- 1.20, and was below - 1 s. d. in 14 patients (58%). BMC, area and BMD increased significantly on GFD. BMD increased from 0.46 +/- 0.13 to 0.55 +/- 0.13 g/cm(2) (P<0.001). BMD Z-score improved from - 1.36 +/- 1.20 to - 0.23 +/- 1.20 after GFD. However, BMD increased more than 1 s. d. in 15 of the 16 children under the age of 4 years, a similar increase was only observed in four of the eight children aged more than 4 years, some of whom did not follow GFD strictly. Height and weight increased significantly with GFD ( Po0.001) and the increase correlated positively with the increase in BMD. Conclusions: Axial BMD below - 1 s. d. was found in 58% of children with celiac disease. Axial bone mass reverted to normal values in most children under the age of 4, who had low bone mass, all of whom followed GFD strictly.