Abstract

Objective: The aim of this study was delineate the burden of low lumbar bone mineral density (BMD) in children with CD (celiac disease) and evaluate differences in BMD according to assessment timing and gluten-free diet (GFD) adherence, using concurrent tissue transglutaminase IgA (c-tTG-IgA), and describe accompanying anthropometric and biochemical profiles.

Materials and Methods: This retrospective cohort included CD patients (n=123) aged 5–18 years who underwent dual-energy X-ray absorptiometry (DEXA) between January 1, 2022, and December 31, 2024. Age-adjusted and height-adjusted BMD z-scores (BMD-AAz and BMD-HAz) were calculated. Patients were grouped as diagnosis or follow-up (≥12 months), and follow-up was subdivided into GFD-non-adherent follow-up group (FU-NonAdh) and GFD-adherent follow-up group (FU-Adh).

Results: Low BMD based on BMD-HAz (≤−1) was present in 37.4% (osteopenia 24.4%; osteoporosis 13.0%). Compared with diagnosis group, follow-up group had higher BMD-AAz and BMD-HAz (p=0.022 and p=0.011). BMD-HAz was higher in FU-Adh group than in diagnosis and FU-NonAdh group (p<0.001 and p=0.005), whereas FU-NonAdh group did not differ from diagnosis group. The low BMD group had a lower body mass index (BMI) z-score and shorter GFD duration (p<0.001 and p=0.010). Serum calcium levels were lower in the osteoporosis group than in the normal BMD group (p=0.003).

Conclusion: Lumbar BMD impairment is frequent in pediatric CD, with the most evident improvement in the GFD-adherent follow-up group. In secondary analyses, lower BMI z-scores and shorter GFD duration were observed in children with low BMD, which may help inform risk stratification.

Keywords: Body mass index, calcium, dual-energy x-ray absorptiometry, gluten-free diet, tissue transglutaminase

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1.
Teke S, Basaran EG. Bone mineral density in pediatric celiac disease: Clinical, biochemical, and serologic profiles—a retrospective cohort study. Turk J Pediatr Dis. 2026;Early View:1-7. https://doi.org/10.12956/TJPD.2025.1274