Bone fractures in children with celiac disease: analysis of clinical and anthropometric measurements and bone metabolism markers

Introduction. Abnormal bone remodelling process is one of the clinical manifestations of celiac disease, which increases the risk of developing osteopenia conditions, including bone fractures. The median age for the first fracture is similar in celiac disease and in the general population, but the incidence is higher in patients with celiac disease.

Aim. To compare clinical and anamnestic characteristics, anthropometric measurements and laboratory test results in celiac children and adolescents with and without bone fractures.

Materials and methods. A total of 151 children aged 1-17 years were included in the study. Patients were divided into two groups: those who had fractures in their lifetime - 21 (13.9%) children and those who had no fractures - 130 (86.1%) children. Results. The frequency of fractures among the patients included in the study was 13.9%, while among children with vitamin D deficiency fractures were reported 2.7 times more often than among children with its optimal level (p = 0.019).

Vitamin D deficiency was detected in 20 (95.2%) children with fractures, and levels of 30 ng/ml or higher were found in 1 (4.8%) child. In the group of patients without fractures, the 25(OH)D optimal level was observed in 43 (33.1%) cases.

It was found that patients with fractures had a significantly lower osteocalcin level than children without fractures - 26.9 (15.6; 32.9) ng/ml (p < 0.001), and children with fractures had C-terminal telopeptide level 1.9 times higher than the group of children without fractures (p = 0.01). The median PTH concentration in children with fractures was 34.6 (19.6; 54.7) pg/ml, whereas in children without fractures it was 24.2 (17.1; 39.5) pg/ml (p = 0.1).

Conclusion. Due to elevated PTH level and severe vitamin D deficiency, a predominance of osteoresorption over osteosynthesis was observed in children with celiac disease and fractures of tubular bones. It is important to maintain a 25(OH)D optimal level and monitor biochemical markers of bone metabolism in patients with celiac disease to assess the processes of bone formation and resorption.

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