ICCBH2015 Poster Presentations (1) (201 abstracts)
Children with coeliac disease on gluten free diet have normal bone mass, geometry and muscle mass
M Mackinder 1 , SC Wong 2 , M Tsiountsioura 1 , S Shepherd 1 , E Tellemer 1 , A Kyriakou 2 , E Buchanan 3 , C Edwards 1 , SF Ahmed 2 , P McGrogan 4 & K Gersimidis 1
1Department of Human Nutrition, University of Glasgow, Glasgow, UK; 2Developmental Endocrinology Research Group, Royal Hospital for Sick Children, Glasgow, UK; 3Department of Dietetic, Royal Hospital for Sick Children, Glasgow, UK; 4Department 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: 38 children (18 males) with CD on GFD for a duration of 3.6 years (0.6, 12.5) underwent pQCT at 4%, 38 and 66% tibial sites. Bloods were collected in CD children only. Results reported as median (range).
Result: 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 (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 z-score), there were no differences between CD and controls for 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.o 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.
| CD (n, 38) | Controls (n, 38) | p value | |
| Age (years) | 10.3 (4.8, 14.8) | 9.3 (4.9, 15.7) | 0.56 |
| Height z-score | −0.2 (−1.5, 2.3) | 0.2 (−2.3, 2.4) | 0.01 |
| BMI z-score | 0.1 (−1.9, 2.2) | 0.4 (−3.1, 2.4) | 0.41 |
| Grip strength (height) z-score | 0.7 (−1.4, 3.4) | 1.1 (−2.0, 3.3) | 0.23 |
| 4% tibia | |||
| Volumetric BMD (mg/cm3) | 288.8 (208.8,421.5) | 304.3 (228.6,419.4) | 0.82 |
| Trabecular BMD (mg/cm3) | 232.2 (153.9,437.8) | 244 (109.2,420.9) | 0.36 |
| Bone area (mm2) | 735.5 (67,1315.8) | 714.6 (318,1313.3) | 0.40 |
| 38% tibia | |||
| Cortical BMD (mg/cm3) | 1044 (974.1,1180.2) | 1059.4 (989.6,1203.8) | 0.37 |
| Cortical area (mm2) | 154.3 (44.5,244) | 158.8 (90.5,268.5) | 0.37 |
| 66% tibia | |||
| Cortical BMD (mg/cm3) | 1020.1 (903.6,1134.9) | 1033.4 (979.6,1165.3) | 0.07 |
| Cortical area (mm2) | 204.1 (93.8,322.5) | 203.8 (102.8,335.8) | 0.85 |
| Periosteal circumference (mm) | 72.6 (54.7,90.8) | 69.4 (55.7,91.6) | 0.38 |
| Endosteal circumference (mm) | 55 (38.1,75.7) | 49.8 (39.5,71.4) | 0.32 |
| Cortical thickness (mm) | 2.7 (1.3,4.5) | 2.8 (1.9,4.1) | 0.43 |
| Muscle density (mg/cm3) | 77.8 (72.1,82.4) | 79.1 (73.1,84.1) | 0.09 |
| Muscle area (mm2) | 3872.3 (241.5,5543.3) | 3400.3 (2190.8,5692.8) | 0.56 |
| Fat area (mm2) | 1695.1 (822.8,3125.8) | 1675.6 (584.8,4184) | 0.63 |
| Bone/muscle area ratio (%) | 5.5 (4.2,6.9) | 5.8 (4.2,8.2) | 0.08 |
Conclusion: This first novel 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 such children with CD. Bone assessment in children with CD at diagnosis and changes with GFD are now needed.
Disclosure: The authors declared no competing interests.
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