Quantitative phalangeal bone ultrasound is normal after long-term gluten-free diet in young coeliac patients

Pedrera, J D; López, M J; Canal, M L; Costa, Cláudio; Mañas, P.D. Benavides; Hernández, E. R.; Rico, H.

doi:10.1097/00042737-200110000-00008

Cited by 15 publications

(10 citation statements)

References 26 publications

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“…The U.S. Food and Drug Administration has recently approved the use of some QUS devices for the routine diagnosis of bone mineral status and determination of fracture risk (17). There are very few data on the assessment of phalangeal QUS in children with bone and mineral disorders (18,19).…”

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confidence: 99%

Assessment of Bone Quality by Quantitative Ultrasound of Proximal Phalanges of the Hand and Fracture Rate in Children and Adolescents with Bone and Mineral Disorders

et al. 2003

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Bone quality by quantitative ultrasound and fracture rate were assessed in 135 (64 males) children and adolescents aged 3-21 y with bone and mineral disorders such as chronic anticonvulsants or glucocorticoids treatment, juvenile rheumatoid arthritis, celiac disease, paucity of intrahepatic bile ducts, autoimmune hepatitis, genetic diseases, idiopathic juvenile osteoporosis, disuse osteoporosis, ␤-thalassemia major, survivors of acute lymphoblastic leukemia, liver transplantation, calcium deficiency, and nutritional or X-linked hypophosphatemic rickets. Amplitude-dependent speed of sound through the distal end of the first phalangeal diaphysis of the last four fingers of the hand was measured by an ultrasound device. In the majority of patients cortical area to total area ratio by metacarpal radiogrammetry (n ϭ 120) and lumbar bone mineral density (BMD) by dual-energy x-ray absorptiometry (n ϭ 99) were also assessed. In patients with X-linked hypophosphatemic rickets radial BMD by single-photon absorptiometry instead of lumbar BMD was measured. Mean values of amplitude-dependent speed of sound, cortical area to total area ratio, lumbar BMDarea, or lumbar BMD corrected for bone sizes estimated by a mathematical model (BMDvolume), as well as mean values of radial BMD in patients with X-linked hypophosphatemic rickets, expressed as z score, were significantly reduced (p Ͻ 0.0001) in comparison with their reference values (Ϫ1.7 Ϯ 1.0, Ϫ2.0 Ϯ 0.9, Ϫ3.0 Ϯ 1.3, Ϫ1.9 Ϯ 1.0, Ϫ2.7 Ϯ 0.7, respectively). A positive relationship was found between amplitudedependent speed of sound and cortical area to total area ratio (r ϭ 0.90, p Ͻ 0.0001), lumbar BMDarea (r ϭ 0.62, p Ͻ 0.0001), or lumbar BMDvolume (r ϭ 0.66, p Ͻ 0.0001). Fifty-two patients (38.5%) had suffered fractures in the 6 mo preceding the bone measurements, the radial distal metaphysis being the most frequent fracture site (28.8%). Mean values of amplitude-dependent speed of sound, cortical area to total area ratio, lumbar BMDarea, or lumbar BMDvolume, expressed as z score, of fractured patients were significantly lower (p Ͻ 0.0001) than those of fracture-free patients (Ϫ2.2 Ϯ 1.0 and Ϫ1.4 Ϯ 0.8, Ϫ2.6 Ϯ 0.9 and Ϫ1.7 Ϯ 0.7, Ϫ3.5 Ϯ 1.2 and Ϫ2.5 Ϯ 1.0, Ϫ2.5 Ϯ 1.0 and Ϫ1.3 Ϯ 0.7, respectively). Phalangeal quantitative ultrasound may be a useful method to assess bone quality and fracture risk in children and adolescents with bone and mineral disorders. DXA has been widely accepted as a noninvasive method for BMD measurement in adults as well as in pediatric subjects (1). An important shortcoming of DXA is that it measures an areal density, so that in growing children BMD is closely related to anthropometric findings and bone sizes (2). Correction of the amount of mineral measured for the apparent bone sizes (BMDvolume) may be a useful tool to reduce the large biologic variation in BMD measurements caused mainly by the confounding influence of age-related changes in bone geometry (2-4).Bone mass studies have recently revitalized the use of metacarpal radiogrammetry to asse...

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confidence: 99%

Assessment of Bone Quality by Quantitative Ultrasound of Proximal Phalanges of the Hand and Fracture Rate in Children and Adolescents with Bone and Mineral Disorders

et al. 2003

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“…Whole body BMC and BMD measurements were within normal limits in another recent study [39]. Finally, bone measurements of SOS have been recently obtained in 99 Spanish adolescents with celiac disease on GFD [47]. Patients were matched with healthy control subjects by age, weight and height.…”

Section: Bone Mass Of Celiac Childrenmentioning

confidence: 73%

Celiac disease in children: Impact on bone health

Mora¹

2008

Rev Endocr Metab Disord

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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.

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“…Phalangeal QUS may be a useful method to assess bone quality and fracture risk in children and adolescents with bone and mineral disorders [ 12 , 20 , 21 ]. Using QUS, similar results as those previously described using DXA have been found in adults [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…As in previous studies [ 12 , 13 , 14 ], all of the children underwent an ultrasound study of the second to fifth proximal phalanges of the non-dominant hand, and the mean of all the measurements was calculate. The QUS study was performed using a model DBM Sonic Bone Profiler (Igea, Capri, Italy) equipped with a caliper that closes tangentially on the phalanx and measures the amplitude-dependent speed of sound (Ad-SoS) in meters per second through the phalanx.…”

Section: Methodsmentioning

confidence: 99%

Greater Calcium Intake is Associated with Better Bone Health Measured by Quantitative Ultrasound of the Phalanges in Pediatric Patients Treated with Anticonvulsant Drugs

et al. 2015

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We aimed to investigate and compare the effects of chronic antiepileptic therapy on bone health in pediatric patients using quantitative ultrasound of the phalanges (QUS) and controlling for potential confounding factors, particularly nutrient intake. The amplitude-dependent speed of sound (Ad-SoS) was measured in 33 epileptic children and 32 healthy children aged 6.5 ± 3.1 and 6.3 ± 1.1 (mean ± SD) years, respectively. There were no significant differences in the demographics such as age, weight and height between epileptic children and the control group children. None of the children in the epileptic or the treatment group were found to have a vitamin D deficiency. There were no significant differences in laboratory tests between groups. Lower QUS figures were found in the epileptic children (p = 0.001). After further adjustment for potential confounders such age, height, weight, calcium intake, vitamin D intake, physical activity and sex, the differences remained significant (p < 0.001). After further classification of the participants based on the tertile of calcium intake, no significant differences were found between patients and healthy controls in the greatest tertile of calcium intake (p = 0.217). We conclude that anticonvulsant therapy using valproate may lead to low bone mass in children and that an adequate intake of calcium might counteract such deleterious effects.

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Quantitative phalangeal bone ultrasound is normal after long-term gluten-free diet in young coeliac patients

Abstract: In patients with CD, gluten-free diet and increased nutritional intake were accompanied by normal bone mass values as determined by ultrasound on phalanges.

Cited by 15 publications

References 26 publications

Assessment of Bone Quality by Quantitative Ultrasound of Proximal Phalanges of the Hand and Fracture Rate in Children and Adolescents with Bone and Mineral Disorders

Assessment of Bone Quality by Quantitative Ultrasound of Proximal Phalanges of the Hand and Fracture Rate in Children and Adolescents with Bone and Mineral Disorders

Celiac disease in children: Impact on bone health

Greater Calcium Intake is Associated with Better Bone Health Measured by Quantitative Ultrasound of the Phalanges in Pediatric Patients Treated with Anticonvulsant Drugs

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