Celiac disease in children: Impact on bone health

Abstract

Celiac disease is a chronic enteropathy caused by permanent intolerance to gluten and similar proteins found in wheat, barley and rye. The intestinal mucosa of susceptible individuals is crossed by undigested gluten, which leads to a marked inflammatory response. The clinical features may vary from overt intestinal symptoms to silent disease. Bone health has been found to be markedly affected in children and adolescents with untreated celiac disease, regardless of clinical presentation. Bone mass measurements are greatly reduced compared to healthy youth. As indicated by surrogate markers of bone turnover, bone formation rates are depressed and bone resorption rates enhanced in untreated patients. The causes underlying alterations in bone metabolism are still under investigation, but are attributed to non-intestinal factors. Increased production of inflammatory cytokines and presence of specific autoantibodies may together disrupt bone metabolism equilibrium in children and adolescents with celiac disease. Gluten withdrawal is able to restore bone mass quite rapidly, with a normalization of levels of bone formation and bone resorption markers. Good adherence to gluten-free diet is mandatory to maintain optimal bone health. Monitoring of dietary compliance is important to ensure appropriate bone mass accrual through childhood and puberty in these patients, to maximize peak bone mass and reduce fracture risk later in life.

Bone mineral density and vitamin K status in children with celiac disease: Is there a relation?

“…A chronic malabsorption of nutrients affects bone formation (vitamins D and K, and calcium), whereas chronic intestinal inflammation (increased production of cytokines and autoimmune alterations) and trace element and magnesium deficiencies may be factors involved in low BMD in patients with CD (4,17). Several adult studies have reported that vitamin K plays an important role in optimizing bone health (18)(19)(20), and an increased fracture risk has been reported in individuals with low vitamin K intake (21).…”

“…Micronutrient malabsorption, inflammatory cytokines, and autoimmunity may impact bone metabolism in CD. Impaired absorption of necessary nutrients for bone mineralization such as calcium and vitamins D and K may represent the principal cause of low BMD (4). Previous studies of adults have proposed that vitamin K exhibits a beneficial role in bone mineral metabolism by acting as a cofactor in the post-translational carboxylation of several bone proteins (5).…”

Prevalence of low bone mineral density in children and adolescents with celiac disease under treatment

“…However, the diagnostic criteria of the European Society of Paediatric Gastroenterology and Nutrition 14 were followed, and these criteria are often used. 7 Therefore, we believe that all of the patients included in the study had celiac disease. Secondly, the cross-sectional design may have led to difficulty in understanding the contributions of late treatment, good adherence to gluten-free diet and duration of treatment towards bone mass.…”

“…[1][2][3][4][5][6][7] Several studies have demonstrated that, independent of the clinical presentation, patients with untreated celiac disease present low bone mineral density (BMD). [1][2][3]5,7,8 Osteopenia is a common public health problem in adults, but can be diagnosed and prevented in childhood. Considering that most of the bone mass is acquired during the first two decades of life, early diagnosis of celiac disease and adherence to a gluten-free diet are of fundamental importance for ensuring adequate bone metabolism in such cases.…”

“…Some authors have detected this recovery over a short duration of adequate follow-up (up to one year), while others have stated that it can only be verified over a longer term. 1,3,7,[11][12][13] …”