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Abstract
The objectives of this study are to determine the incidence of reduced Bone Mineral Apparent Density (BMAD) in children diagnosed with coeliac disease, to identify risk factors for reduced BMAD and to quantify seroconversion rate to negative IgA anti-tissue transglutaminase antibodies (TTG) on gluten-free diet (GFD).
A list of coeliac patients is kept by the gastroenterology department. Relevant information was extracted from patient records. All children diagnosed between 2004–2021, with > 1-year follow-up, were included. GraphPad Prism (San Diego, CA) was used for univariable logistic regression analysis.
179 (118 F) patients were identified. Mean age at diagnosis is 7.6 years. (Range 11 months – 17 years). 133 patients underwent at least one DEXA scan. At first scan, 100 children had normal BMAD (Z score ≥-1), 19 had osteopenia (Z score <-1 and ≥ -2) and 13 had osteoporosis (Z score <-2). At their latest scans, 3 still had osteopenia and only one still met the criteria for osteoporosis. (See graph 1) The median interval between starting gluten-free diet and first DEXA was 1.2 years (range 1 week – 10 years). 159 children had TTG levels checked >1 year after starting GFD. Of these, 81 achieved full seroconversion to negative TTG. Low body mass index (BMI) correlated with low BMAD (p=0.02). Using BMI for risk discrimination by ROC curve analysis was valid. (See graph 2) A significant relationship between TTG, vitamin D level, ALP or serum calcium, and low BMAD was not demonstrated (P>0.5).
Persistent osteoporosis among children with coeliac disease following a gluten-free diet is very rare. Low BMI is a predictor of osteoporosis. Targeted DEXA screening has a place in the current management of coeliac disease whereas routine screening does not.
Classification of DEXA scan results according to BMAD Z scores
Unvariable logistic regression analysis by graphpad prism