title: Bone health in children with celiac disease assessed by dual x-ray absorptiometry: effect of gluten-free diet and predictive value of serum biochemical indices.
abstract: OBJECTIVE
  In the present study, we aimed to assess bone status and the effect of gluten-free diet (GFD) in children with celiac disease (CD), and to evaluate the predictive value of standard serum biochemical indices in the diagnosis of bone mineral density (BMD) disturbances.
  
  
  METHODS
  Forty-five children at the time of diagnosis of CD (group A, 77.8% girls) and 36 children receiving GFD for >2 years (group B, 75% girls) were included. Sixteen children in group A were reexamined 12 months after initiation of GFD. Serum measurements of biochemical bone health indices and BMD, assessed by dual x-ray absorptiometry, were obtained.
  
  
  RESULTS
  Patients after 1 year of receiving GFD had higher BMD z scores compared with baseline (-1.45 ± 0.28 vs -0.61 ± 0.25, respectively, P = 0.004). BMD z scores were significantly lower than expected for the normal population, after 1 (P = 0.03) or at least 2 (P < 0.001) years of receiving GFD. In group B, BMD z score was positively correlated with 25-hydroxy vitamin D levels (P = 0.009). In the repeated measurements group, 25-hydroxy vitamin D differed between pre- and post-GFD (P = 0.018). No biochemical index was capable of predicting an abnormal BMD z score (receiver operating characteristic curve analysis, all of the areas under the curve <0.66).
  
  
  CONCLUSIONS
  GFD has a beneficial effect on bone health. Two years receiving diet do not ensure normalization. Biochemical markers are not indicative of BMD disturbances. Dual x-ray absorptiometry should be included in the standard management of children with CD.
authors.affiliation: First Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.
authors.forename: Daphne
authors.initials: D
authors.lastname: Margoni
authors.forename: Giorgos
authors.initials: G
authors.lastname: Chouliaras
authors.forename: Grigoris
authors.initials: G
authors.lastname: Duscas
authors.forename: Irene
authors.initials: I
authors.lastname: Voskaki
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Voutsas
authors.forename: Anna
authors.initials: A
authors.lastname: Papadopoulou
authors.forename: Joanna
authors.initials: J
authors.lastname: Panayiotou
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Roma
mesh_terms: D015502:Absorptiometry, Photon; D015415:Biomarkers / Q000097:blood*; D015519:Bone Density; D001842:Bone and Bones / Q000473:pathology*; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014807:Vitamin D / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D015415:Biomarkers; D014807:Vitamin D; C104450:25-hydroxyvitamin D