A prospective, longitudinal study of the long-term effect of treatment on bone density in children with celiac disease.
OBJECTIVE
Because osteopenia is a frequent complication of celiac disease, we evaluated the impact of a long-term gluten-free diet (GFD), initiated during childhood, on bone density. study design: Patients with celiac disease (n = 19; mean age, 14.2 +/- 2.6 years) were studied after 4.3 +/- 0.6 years of GFD. Bone density had been measured at diagnosis and after 1 year of GFD. We also studied 211 healthy children as a control group. Bone mineral density was measured by dual-energy x-ray absorptiometry. Intact parathyroid hormone (PTH) and bone-specific alkaline phosphatase (BALP) levels were measured in serum, and N-terminal telopeptide of type I collagen (NTx) was measured in urine.


RESULTS
Although at diagnosis bone mineral content, bone area, and bone mineral density were significantly lower than in control subjects, the 3 measurements were normal after GFD. None of the patients on a GFD showed elevated values of PTH. Patients on a GFD had BALP (110.2 +/- 67.2 U/L) and NTx levels (261.9 +/- 187.8 nmol bone collagen equivalents/mmol creatinine) that were significantly higher than those of control subjects. The levels of BALP and NTx were significantly higher in patients with good compliance with the GFD, compared with patients with poorer compliance.


CONCLUSIONS
This study shows that bone mineral content, bone area, and bone mineral density improve significantly with a GFD.
Mora
S
S
Laboratory of Pediatric Endocrinology, Scientific Institute H San Raffaele, University of Milan, Milan, Italy.
Barera
G
G
Beccio
S
S
Menni
L
L
Proverbio
M C
MC
Bianchi
C
C
Chiumello
G
G
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D015519:Bone Density / Q000502:physiology*; D002446:Celiac Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000178:diet therapy*; D002648:Child; D024042:Collagen Type I / Q000652:urine; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D009747:Nutritional Physiological Phenomena / Q000502:physiology; D010281:Parathyroid Hormone / Q000097:blood; D010349:Patient Compliance; D011446:Prospective Studies; D013997:Time Factors
D024042:Collagen Type I; D010281:Parathyroid Hormone; D000469:Alkaline Phosphatase