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 d uring 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 m easured at diagnosis and after I year of GFD. We also studied 211 healthy c hildren as a control group. Bone mineral density was measured by dual-energ y x-ray absorptiometry. Intact parathyroid hormone (PTH) and bone-specific alkaline phosphatase (BALP) levels were measured in ser-um, and N-terminal telopeptide of type I collagen (NTx) was measured in urine. Results: Although at diagnosis bone mineral content, bone area, and bone mi neral density were significantly lower than in control subjects, the 3 meas urements were normal after GFD. None of the patients on a GFD showed elevat ed values of PTH. Patients on a GFD had BALP (110.2 +/- 67.2 U/L) and NTx l evels (261.9 +/- 187.8 nmol bone collagen equivalents/mmol creatinine) that were significantly higher than those of control subjects. The levels of BA LP 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 bon e mineral density improve significantly with a GFD.