Effect of a gluten-free diet on bone mineral density in children with celiac disease

Abstract

Aim: The aim of the study was to assess the evolution of bone mineral density (BMD) in children with celiac disease and to evaluate the effect of a gluten-free diet (GFD).

Methods: Altogether, 44 children (31 girls and 13 boys) were followed-up. BMD was measured by dual-energy X-ray absorptiometry of the lumbar spine (Hologic QDR 4500). Results are expressed as absolute values for BMD, and as Z scores for chronological age (BMD/CA) and bone age (BMD/BA). Patients were divided into two groups according to whether they followed a diet without (n=34) or with (n=10) gluten for at least 1 year. All patients were clinically free of symptoms at the end of the follow-up.

Results: At inclusion, 26 patients (59%) were delayed in bone age, 17 children (38%) had a BMD/CA< or =1 S.D. and six (13.6%) had a BMD/CA< or =2 S.D., whereas nine children (20%) had a BMD/BA< or =1 S.D. and three (6.8%) had a BMD/BA< or =2 S.D. During the follow-up, the BMD increase was greater in the GFD group, as determined by the BMD/CA/year (+0.05+/-0.3 vs -0.34+/-0.4 S.D.; P<0.01) and BMD/BA/year (-0.02+/-0.4 vs -0.4+/-0.6 S.D.; P<0.05). The gain in BMD/BA was smaller in the GFD group because of their need to catch up in bone maturation.

Conclusion: Celiac children not following a GFD show delays in both bone maturation and mineralization. This prospective study confirms the importance of maintaining a GFD in children with celiac disease until the end of skeletal mineralization even in asymptomatic patients following a non-restricted diet.