Objectives: Osteoporosis and alterations of bone metabolism are frequent complications of celiac disease. We evaluated the impact of long-term gluten- free diet (GFD) initiated during childhood and adolescence on bone mineralization and bone metabolism. Methods: We studied 30 celiac patients on GFD for ≥5 yr. The mean age at diagnosis was 11.4 ± 5.0 yr, and the mean duration of GFD was 10.7 ± 4.3 yr. Results were compared with those obtained in 240 healthy controls. Bone mineral density (BMD) was measured in the lumbar spine and in the whole skeleton by dual-energy x-ray absorptiometry. Serum levels of bone-specific alkaline phosphatase (BALP) and N-terminal propeptide of type I procollagen (PINP) were measured as bone formation indices, and urine levels of N-telopeptide of type I collagen (NTx) as bone resorption index. Results: BMD measurements of celiac patients (lumbar spine: 1.131 ± 0.121 g/cm 2; total body: 1.145 ± 0.184 g/cm 2) did not differ from those of control subjects (lumbar spine: 1.131 ± 0.184 g/cm 2; total body: 1.159 ± 0.118 g/cm 2). The levels of BALP, PINP, and NTx of celiac patients did not differ from those of controls. Patients who started GFD before puberty had BMD and bone metabolism measurements comparable to those of patients who started GFD during puberty. Conclusions: Our data show that long-term dietary treatment ensures normal mineralization and bone turnover.
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