title: Effect of a gluten-free diet on bone mineral density in children with celiac disease.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Child and Adolescent Medicine, Hospital Sud, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France.
authors.forename: R
authors.initials: R
authors.lastname: Heyman
authors.forename: P
authors.initials: P
authors.lastname: Guggenbuhl
authors.forename: A
authors.initials: A
authors.lastname: Corbel
authors.forename: L
authors.initials: L
authors.lastname: Bridoux-Henno
authors.forename: Y
authors.initials: Y
authors.lastname: Tourtelier
authors.forename: M
authors.initials: M
authors.lastname: Balençon-Morival
authors.forename: M
authors.initials: M
authors.lastname: de Kerdanet
authors.forename: A
authors.initials: A
authors.lastname: Dabadie
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000365:Age Determination by Skeleton; D015519:Bone Density; D001846:Bone Development; D001851:Bone Diseases, Metabolic / Q000178:diet therapy / Q000209:etiology; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy*; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae; D008297:Male; D011446:Prospective Studies