Prevalence of low bone mineral density in children and adolescents with celiac disease under treatment

Abstract

CONTEXT AND OBJECTIVE: Low bone mineral density may be a finding among children and adolescents with celiac disease, including those undergoing treatment with a gluten-free diet, but the data are contradictory. The aim of this study was to determine the frequency of bone mineral density abnormalities in patients on a gluten-free diet, considering age at diagnosis and duration of dietary treatment. DESIGN AND SETTING:Cross-sectional prevalence study at the Pediatric Gastroenterology Outpatient Clinic of Instituto Materno Infantil Professor Fernando Figueira.METHODS: Thirty-one patients over five years of age with celiac disease and on a gluten-free diet were enrolled. Bone mineral density (in g/cm 2 ) was measured in the lumbar spine and whole body using bone densitometry and categorized using the criteria of the International Society for Clinical Densitometry, i.e. low bone mineral density for chronological age ≤ -2.0 Z-scores. Age at diagnosis and duration of dietary treatment were confirmed according to the date of starting the gluten-free diet.RESULTS: Low bone density for chronological age was present in 3/31 patients in the lumbar spine and 1/31 in the whole body (also with lumbar spine abnormality). At diagnosis, three patients with low bone mineral density for the chronological age were more than 7.6 years old. These patients had been on a gluten-free diet for six and seven months and 3.4 years. CONCLUSION:Pediatric patients with celiac disease on long-term treatment are at risk of low bone mineral density. Early diagnosis and long periods of gluten-free diet are directly implicated in bone density normalization.RESUMO CONTEXTO E OBJETIVO: Baixa densidade mineral óssea pode ser encontrada em crianças e adolescentes com doença celíaca, incluindo aqueles em tratamento com dieta sem glúten, mas dados são contraditórios. O objetivo deste estudo foi determinar a frequência de alteração da densidade mineral óssea nos pacientes em dieta sem glúten, conforme a idade ao diagnóstico e o tempo de tratamento dietético. TIPO DE ESTUDO E LOCAL: Foi realizado estudo transversal de prevalência no Ambulatório de Gastroenterologia Pediátrica do Instituto Materno Infantil Professor Fernando Figueira (IMIP).MÉTODOS: Trinta e um pacientes maiores de cinco anos com doença celíaca que estavam em dieta sem gluten foram avaliados. A densidade mineral óssea (em g/cm 2 ) foi medida na coluna lombar e no corpo inteiro utilizando densitometria óssea, categorizando-a pelo critério da Sociedade Internacional para Densitometria Clínica (baixa densidade mineral óssea para a idade cronológica ≤ -2.0 escores Z). A idade ao diagnóstico e o tempo de tratamento foram confirmados pela data de início da dieta sem glúten.RESULTADOS: Baixa densidade mineral óssea para a idade cronológica foi detectada em 3/31 pacientes na coluna lombar e 1/31 no corpo inteiro (também apresentava alteração da coluna lombar). Ao diagnóstico, três pacientes com baixa densidade mineral óssea para a idade cronológica estavam com mais de 7,6 anos. Esses pacient...

Vitamin D and K status influences bone mineral density and bone accrual in children and adolescents with celiac disease

“…This occurred in a population of relatively young children with seemingly normal growth and nutritional status, independent of the presence or absence of GI symptoms at time of diagnosis. Interestingly, the risk for poor bone health did not change after 1 year on the GFD, but was significantly higher in older children and adolescents (410 years), indicating that time to diagnosis is an important factor to bone health in CD (Motta et al, 2009;Blazina et al, 2010). In addition, it shows that the length of time to recover suboptimal bone accrual in children with CD exceeds 1 year, even with compliance to dietary treatment.…”

Nutritional Status in Spanish Children and Adolescents with Celiac Disease on a Gluten Free Diet Compared to Non-Celiac Disease Controls

“…Related to this nutritional deficiency, currently, there is an emerging need for early assessment of bone mineral density (BMD) to treat bone abnormalities in celiac patients, since bone disorders are well documented [60,61,62,63]. Thus, Krzesiek et al [64] observed a reduction in BMD in 40% of children with diagnosed CD and in 75% in patients with newly diagnosed CD.…”

Bone mineral density and growth in children with coeliac disease on a gluten free-diet

“…The relationship between low bone density and CD in children has been described in previous studies. Both cross-sectional and longitudinal studies have revealed variable but remarkable improvements in bone mass during consumption of a GFD (4)(5)(6)(7)(8)(9)(10)(11)18,19). We showed that BMD was significantly lower in patients with CD, but significantly improved during the first year of a GFD.…”