Change in Bone Mass after Gluten free Diet in Celiac disease Patients with Gastrointestinal and Non-Gastrointestinal Presentations: An Interventional Study

Background and aim: Celiac disease (CD) is an autoimmune enteropathy and gluten free diet (GFD) is the only treatment available till now. Although previous studies had shown that patients with non-gastrointestinal symptoms have osteopenia but there is scanty literature on the effect of GFD on Bone Mass Density (BMD) improvement in celiac disease patients with or without gastrointestinal symptoms in childhood.Methods :A prospective interventional study was conducted in a tertiary care institute in which newly diagnosed children 1 to 14 years of age presented to Pediatrics OPD or admitted in ward with symptoms suggestive of CD and IgA tissue transglutaminase level 10 folds of normal level were taken as cases. Children with other associated diseases like Type 1 Diabetes Mellitus, Hypothyroidism and who were non-compliant to GFD diet were excluded. Those children were later grouped into as children with gastrointestinal and children with non-gastrointestinal symptoms. DEXA scan was done in both the groups at presentation and after 6 months of gluten free diet to determine bone mass density. The results were later compiled and analysed . P value of <0.05 was taken as significant.Results: A total of 50 patients were enrolled in the study in which 25 patients were in each group. In children with gastrointestinal symptoms, 10 (40%) children had osteopenia (Z-score below -1) and 2 patients had severe osteopenia (Z-score below -2.5) where as in other group with non-gastrointestinal symptoms, 11(44%) has osteopenia and 3 had severe osteopenia. After 6 months of GFD there was significant improvement in mean Z-score, mean BMD and mean BMC(p<0.001) in both the groups however complete restoration was not achieved.Conclusions: Our study clearly showed that children without gastrointestinal symptoms had osteopenia of almost same degree as children with these symptoms (p >0.05). There is a significant beneficial effect of GFD on bone mass in both the groups (gastrointestinal as well as non-gastrointestinal) separately. Such results emphasize early detection and role of GFD intreatment of osteopenia in these children to have adequate bone mass in the puberty.