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

Objectives Osteoporosis is a complication of coeliac disease. A gluten-free diet improves but does not normalize bone mineral density in adult patient s. Only limited data are available regarding the influence of the disease a nd diet on bone mineralization in children. The aim of this study was to ev aluate the radial bone mineral content and density in children and adolesce nts who are asymptomatic on a gluten-free diet. Subjects and methods The bone mineral content (BMC) and density (BMD) value s of the non-dominant radius midshaft in 91 children (53 girls, 38 boys, me an age 11.7 years, mean duration of disease 8.7 years) were determined by s ingle-photon absorptiometry. At the diagnosis and at least three years afte r commencement of a gluten-free diet, serum calcium, phosphorus, albumin co ncentrations and alkaline phosphatase activities were measured in all patie nts, and intact parathormone concentrations in 16 patients. Results The mean BMC Z-score value in the female adolescent group only was significantly lower than normal (mean Z-score -1.04, P < 0.01). In contrast , the mean BMD Z-score was significantly higher compared to a healthy popul ation both in girls (mean Z-score +1.36, P < 0.001) and in boys (mean Z-sco re +0.53, P < 0.02), as well as in the total patient group (mean Z-score +1 .01, P < 0.001). The radial diameter was significantly smaller than normal in both pre-pubertal and adolescent groups. Serum laboratory parameters of asymptomatic patients were in the normal range. The parathormone mean value was significantly lower after at least three years of gluten-free diet tha n at diagnosis (mean +/- SD 3.77 +/- 1.07 versus 7.89 +/- 2.54 pmol/l, P < 0.01), but significantly higher compared to controls (2.89 +/- 0.90 pmol/l, P < 0.05). Conclusions These data indicate that treated, asymptomatic coeliac children and adolescents have normal or even higher radius mineral density values t han controls, but the bone size remains reduced. Although there is no direc t evidence of calcium malabsorption in this cohort of coeliac patients, the slightly higher parathormone levels, together with some other factors, par ticularly delayed puberty, may result in reduced bone size, Eur J Gastroent erol Hepatol 13:419-424 (C) 2001 Lippincott Williams & Wilkins.