Celiac Disease, Gluten-Free Diet, and Bone Mass Density

REVIEW ARTICLE Background: Celiac disease (CD), as an autoimmune disease has initiated since ingestion of food containing gluten. Constant intolerance to gluten causes damages of the small intestinal mucosa. One reason of mal-absorption in children and infants is CD. Additionally, about 75% of newly identified patients with CD have low bone mineral density (BMD). Many factors have role in metabolic bone diseases, such as disturbance in calcium absorption, consumption of endogenous calcium, fecal loss, damaged to vitamin D absorption, and inflammatory mediators. The gluten free diet (GFD) is the only efficacious treatment for CD. Low BMD which is a prevalent problem of untreated CD may be restored by GFD. Methods: Databases of PubMed, Web of science, Google scholar, Scopus and Embase were searched by the following keywords: CD and GFD, CD and BMD, GFD and children up to July 2016. Results: Most children with CD already have reduced bone mass density before treatment with GFD. GFD caused normal bone mineral density in most of celiac children and adolescent. The treatment duration for restoration of bone mass was not obvious. There were no similar time points for all patients, thus the duration of treatment was different. There was a relationship between age of patients at diagnosis and therapeutic intervention and recovery of BMD; older children may have slower grades of improvement. Conclusions: GFD has an important role in bone health. If CD is diagnosed and managed before adolescence, children with CD may achieve normal bone mass.