A prospective, longitudinal study of the long-term effect of treatment on bone density in children with celiac disease☆

Abstract 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 dualenergy 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. (J Pediatr 2001;139:516-21)