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Reduced Bone Mineral Density in Children With Screening-detected Celiac Disease
Sara Björck1, Charlotte Brundin, Magnus Karlsson
1*Unit of Diabetes and Celiac Disease, Department of Clinical Sciences, Lund University, Malmö †Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Malmö, Sweden.
Insights
Children with screening-detected celiac disease show impaired bone mass and metabolism, including lower bone mineral density (BMD) and vitamin D levels. Early diagnosis and a gluten-free diet effectively reverse these celiac disease complications.
Area of Science:
- Pediatric endocrinology
- Gastroenterology
- Immunology
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- Genetic predisposition plays a significant role in CD development.
- Early detection of CD in at-risk children is crucial for timely intervention.
Purpose of the Study:
- To investigate bone mass and metabolism in genetically at-risk children with screening-detected celiac disease.
- To compare bone mineral density (BMD), vitamin D, parathyroid hormone (PTH), and inflammatory markers between children with CD and controls.
- To evaluate the impact of a gluten-free diet (GFD) on these parameters in children with CD.
Main Methods:
- Dual-energy X-ray absorptiometry (DXA) for BMD assessment (total body and spine).
- Biochemical analysis of serum 25(OH) vitamin D3, PTH, and various cytokines (IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-13, TNF-α).
- Comparison between children with screening-detected CD (at diagnosis and on GFD) and matched controls.
Main Results:
- Children with screening-detected CD at diagnosis exhibited significantly reduced BMD (total body and spine) compared to controls.
- Lower serum 25(OH) vitamin D3 and higher PTH levels were observed in children with CD at diagnosis.
- Elevated systemic inflammatory markers (cytokines) were present in children with CD at diagnosis, which normalized in those on a GFD.
Conclusions:
- Screening-detected celiac disease in children is associated with impaired bone metabolism and systemic inflammation at diagnosis.
- These adverse effects are reversible with early diagnosis and adherence to a gluten-free diet.
- Early intervention in pediatric celiac disease is vital for preventing long-term complications like bone density loss.
Objectives:
The aim of the study was to assess whether bone mass and metabolism are impaired in genetically at-risk children with screening-detected celiac disease.
Methods:
Included were 71 children with screening-detected celiac disease diagnosed at 10.0 ± 0.7 (mean ± standard deviation) years and 142 matched controls and 30 children with screening-detected celiac disease diagnosed at 3.3 ± 0.4 years of age presently on a gluten-free diet for 6.9 ± 1.1 years and 60 matched controls. All participants were assessed for bone mineral density (BMD) of total body and spine by dual x-ray absorptiometry, serum 25(OH) vitamin D3, parathyroid hormone (PTH), interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-15, interferon gamma, and tumor necrosis factor alpha.
Results:
At diagnosis, screening-detected celiac disease children as compared to controls had a mean -0.03 g/cm reduced BMD of both total body and spine (P = 0.009 and P = 0.005, respectively), a mean -11.4 nmol/L lower level of 25(OH) vitamin D3 (P < 0.001), and a mean +1.0 pmol/L higher PTH level (P < 0.001). Systemic levels of the cytokines IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-13, and tumor necrosis factor alpha were all increased in screening-detected celiac disease as compared to controls (P < 0.001). No difference in BMD, 25(OH) vitamin D3, PTH, and cytokine levels were detected in children on a gluten-free diet compared with controls.
Conclusions:
Children with screening-detected celiac disease have reduced BMD, lower levels of vitamin D3, higher levels of PTH, and signs of systemic inflammation compared with controls. These differences were not found in celiac disease children on a gluten-free diet, indicating that children with screening-detected celiac disease benefit from an early diagnosis and treatment.
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