ESPE Abstracts (2015) 84 P-2-204

Children with Coeliac Disease on Gluten Free Diet have Normal Bone Mass, Geometry and Muscle Mass

M Mackindera, S C Wongb, M Tsiountsiouraa, S Shepherdb, E Buchananc, C Edwardsa, S F Ahmedb,d & K Gerasimidisa


aDepartment of Human Nutrition, University of Glasgow, Glasgow, UK; bDevelopmental Endocrinology Research Group, Royal Hospital for Sick Children, Glasgow, UK; cDepartment of Dietetics, Royal Hospital for Sick Children, Glasgow, UK; dDepartment of Paediatric Gastroenterology, Royal Hospital for Sick Children, Glasgow, UK


Objective: To evaluate musculoskeletal development using pQCT in children with coeliac disease (CD) on gluten free diet (GFD) compared with age and gender matched healthy controls.

Method: Prospective cross sectional study. 38 children (18 males) with CD on GFD for a duration of 3.6 years (0.6, 12.5) and 38 age and sex matched healthy controls underwent pQCT at 4, 38 and 66% tibial sites. Bloods were collected in CD children only. Results reported as median (range).

Result: Median age for CD healthy controls were 10.3 years (4.8, 14.8) and 9.3 years (4.9, 15.7) respectively. Median height SDS for CD and healthy controls were −0.2 (−1.5, 2.3) and +0.2 (−2.0, 2,4) respectively (P=0.01). Median grip strength adjusted for height SDS for CD and healthy controls were 0.7 (−1.4, 3.4) and 1.1 (−2.0, 3.3) respectively. Median TTG was 1.8 IU/L (0.1, 114) with 30/38 (79%) children with TTG< 8 IU/. Median biagi score that verifies compliance to GFD was 3 (0.0, 4.0) with 32/35 (91.4%) scoring 3 and 4 (score of 3 and 4=good compliance). Median 25-hydroxyvitamin D was 49.5 nmol/l (21, 82). 1/34 (2.9%) had 25-hydroxyvitamin D <25 nnmol/l. All children had normal serum calcium, phosphate, PTH and thyroid function. A history of fracture was reported in 7/38 (18%) of CD and 5/38 (13.2%) of healthy controls. In adjusted regression model (age, height SDS), there were no differences between CD and controls for pQCT bone area (95%CI −341.1 to +204.6, P=0.62), muscle area (95%CI −27.8 to +284.1, P=0.97), periosteal circumference (95%CI −4.6 to +1.7, P=0.37), endosteal circumference (95%CI −6.0 to +1.8, P=0.28) and cortical thickness (95%CI −0.1 to +0.4, P=0.33). There were no significant associations between pQCT bone parameters with TTG, Biagi score, 25-hydroxyvitamin D or calcium in CD. There were no significant associations between pQCT bone parameters and grip strength in CD and healthy controls.

Conclusion: This first report of bone mass and geometry using pQCT in a group of children with CD on GFD demonstrates normal volumetric BMD and bone geometry compared with healthy controls. Our data questions the need for routine bone surveillance in children with CD who are compliant with GFD.

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