Skeletal and Muscular Status in Juveniles With GFD Treated Clinical and Newly Diagnosed Atypical Celiac Disease—Preliminary Data

Abstract 

Undiagnosed and untreated celiac disease (CD) constitutes an increasing skeletal health problem due to its association with low bone density and fractures. Examinations of skeletal status in children using dual-energy X-ray absorptiometry (DXA) are prone to size-related misinterpretation. In contrary, the analysis of muscle–bone relationship seems to limit a possibility of misdiagnosis because skeletal status is evaluated from the functional perspective. The study was aimed to assess skeletal status of children suffering from CD with the use of muscle–bone functional algorithm. The study group comprised 29 celiac patients (13.7yr±2.9) on gluten-free diet (GFD), and 24 newly diagnosed atypical celiac patients, including subgroup with normal height (n=14; 12.6yr±3.9) and subgroup with short stature (n=10; 12.2yr±2.9). Muscular and skeletal status was evaluated by DXA (DPX-L, GE). Anthropometry, total body bone mineral density (TBBMD, g/cm²). and total body bone mineral content (TBBMC, g) as well as lean body mass (LBM, g) were evaluated. Muscle–bone interactions were estimated using TBBMC/LBM ratio. Previously established references for healthy controls were used for the calculation of Z-scores (age-matched) and SD-scores (height-matched). GFD treated celiacs and atypical celiacs with normal body height had TBBMD, TBBMC, LBM, and TBBMC/LBM ratio Z-scores and SD-scores within normal range for healthy controls. In contrary, atypical celiacs with short stature had significantly lower Z-scores for TBBMD (−2.3±0.4), TBBMC (−2.1±0.3), LBM (−1.4±0.3). and TBBMC/LBM ratio (−2.3±0.6) when compared to respective values observed in GFD treated celiacs (p<0.001, p<0.001, p<0.05, p<0.01) and atypical celiacs with normal height (p<0.01, p<0.01, p<0.05, p<0.01). When body-height matching of DXA data was used to limit the influence of body size, the atypical celiacs with short stature had SD-scores for TBBMD (−1.3±0.7), TBBMC (−1.3±0.6), and LBM (+0.8±0.3) not significantly different from the corresponding SD-scores obtained in the remaining 2 groups. Nevertheless, short stature in atypical celiacs still coincided with significantly lower TBBMC/LBM ratio SD-score of −1.9±0.7 when compared to values observed in GFD treated celiacs (+0.04±0.2; p<0.05) and atypical celiacs with normal height (−0.4±0.2; p<0.05). GFD regime in classic celiacs corresponded with physiological values of DXA assessed indicators of bone and muscle status as well as normal muscle–bone interactions. Untreated atypical celiacs may present a broad spectrum of heterogeneous abnormalities from normal to markedly depressed TBBMC/LBM ratio values pointing on the marked imbalance between TBBMC and LBM.

Key Words: Bone density, celiac disease, DXA, fractures, muscles