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Bone mineral density in Iranian children with celiac disease
Shokoufeh Ahmadipour1, Mohamad Rostami Nejad2,3, Mojgan Faraji Goodarzi4
1Pediatric Gastroenterologist, Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
Insights
Children with advanced celiac disease often have low bone mineral density (BMD), particularly in the lumbar spine. Screening for metabolic bone diseases is crucial, even in early stages of celiac disease.
Area of Science:
- Pediatric Rheumatology
- Gastroenterology
- Endocrinology
Background:
- Celiac disease (CD) has widespread extraintestinal manifestations, including osteoporosis, which can be devastating if overlooked.
- Osteoporosis in CD often goes undiagnosed until severe, posing a significant burden on patients and healthcare systems.
- The prevalence and characteristics of osteoporosis in Iranian pediatric CD patients remain largely unknown.
Purpose of the Study:
- To evaluate bone mineral density (BMD) in pediatric patients diagnosed with celiac disease.
- To investigate the prevalence and characteristics of low bone density in children with Marsh II and Marsh III celiac disease in Iran.
Main Methods:
- A cross-sectional study was conducted with 48 pediatric patients (under 18) diagnosed with Marsh II/III celiac disease.
- Data collected included patient demographics, clinical information, biochemical parameters, and bone mineral density (BMD) via dual-energy x-ray absorptiometry.
- BMD was assessed at femoral and lumbar regions.
Main Results:
- Low bone density was observed in 22.9% of patients in the femoral region and 35.4% in the lumbar region.
- No significant correlation was found between age, sex, residence, Marsh stage, or gluten-free diet adherence and BMD.
- A significant association was found between lumbar bone density and HLA types DQ8 and DQ2/8 (P=0.016).
Conclusions:
- Children with advanced celiac disease (Marsh II and III) should be screened for metabolic bone diseases.
- Low bone mineral density (BMD) screening should also be considered for patients in Marsh I stage of celiac disease.
Aim:
The current study aims to evaluate bone mineral density (BMD) in patients with celiac disease who were referred to the celiac clinic of Shahid Rahimi Hospital in Khorramabad, Iran, in 2020.
Background:
Extraintestinal presentations of celiac disease are widespread and, if neglected, can be devastating. Osteoporosis, one of the extraintestinal manifestations of celiac disease, often remains undiagnosed until advanced stages and can impose a significant burden on patients with celiac and health systems. Nonetheless, the prevalence and characteristics of osteoporosis in celiac disease are unknown in Iran.
Methods:
This was a cross-sectional study at the celiac clinic of Shahid Rahimi Hospital in Khorramabad, Iran. Participants were 48 patients under 18 years diagnosed with Marsh II and Marsh III stages of celiac disease (who need to be on a gluten-free diet) at the pediatrics celiac clinic in 2020. All patients were recruited, completed a questionnaire, and had their blood biochemical parameters analyzed. Then their bone mineral density (BMD) was measured through dual-energy x-ray absorptiometry at the Asia Imaging Center in Khorramabad under the supervision of a radiologist and pediatric rheumatologist.
Results:
The mean age of the children was 9.96±3.17 years. The minimum and maximum ages of the participants were 4 and 17 years, respectively. Of all 48 children who were included (48), 34 (70.8%) were female, and 14 (29.2%) were male. In the femoral region bone densitometry, 35.4% were normal, 41.7% had lower limit normal, and 22.9% had low bone density. In the lumbar region, 39.6% were normal, 25% were Lower limit normal, and 35.4% had low bone density. No significant correlation was found between age, sex, place of residence, Marsh stage, gluten-free diet, and bone densitometry in both lumbar and femoral regions. Nonetheless, we detected a statistically significant relationship between bone density in the lumbar region and two HLA types, namely HLA DQ8 and HLA DQ2/8 (P=0.016).
Conclusion:
The results of the current study provided further evidence that all children with advanced celiac disease should be screened for metabolic bone diseases. Besides those in Marsh II and Marsh III, patients in Marsh I stage should also be investigated for low bone mineral density.
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