Managing Bone Health in Pediatric Celiac Disease: Effects of a Gluten-free Diet and Calcium-vitamin D Therapy

Aim: Celiac disease is an autoimmune disease affecting individuals of all ages, causing damage to the small intestines upon consuming gluten.This study aimed to assess changes in bone mineral density among children with celiac disease following dietary intervention and treatment compared to their pre-intervention levels, and also to determine the frequency of metabolic bone disease at the time of diagnosis.Materials and Methods: This study included pediatric patients with biopsy-proven celiac disease who underwent dual-energy X-ray absorptiometry at diagnosis and after 12 months.Anthropometric measurements, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25-hydroxyvitamin D levels were recorded.Lumbar spine (L1-L4) bone mineral density was measured using a dual-energy X-ray device.Anthropometric measurements, dual-energy X-ray absorptiometry results, and biochemical laboratory findings were evaluated before and after treatment.All patients received standardized vitamin D (400-2,000 IU/day based on their deficiency status) and calcium supplementation (age-appropriate daily intake 800-1,300 mg/day) based on their baseline deficiency status, and their adherence to a gluten free diet was verified by clinical improvement and negative anti-tissue transglutaminase IgA at follow-up.Results: Sixty children (36 female, 24 male; mean age 8.823.90years) were included in this study.At the initial evaluation, low bone mineral density was identified in 25% of the patients.During follow-up, some patients demonstrated worsening dual-energy X-ray absorptiometry findings despite adherence to the diet.Further assessment revealed that these patients had vitamin D deficiency and were non-compliant with the prescribed supplementation.Conclusion: These findings highlight the critical role of dietary management and appropriate supplementation in managing celiac disease, emphasizing the necessity for dual-energy X-ray absorptiometry screening at diagnosis and follow-up.