Effect of gluten-free diet on bone mineral content in growing patients with celiac disease.

Osteoporosis is a complication of celiac disease in adulthood, but little is known about the influence of the disease on bone mineralization in children. In the present study we evaluated radial bone mineral content (BMC) in celiac children and adolescents at diagnosis and after they consumed a gluten-free diet (GFD). The BMC values of 33 celiac patients at diagnosis were significantly lower than those of 255 control subjects (P < 0.001). There was no difference between diabetic and non-diabetic celiac patients. In 14 patients the BMC increased significantly (P < 0.05, ANCOVA) after 1.28 y of GFD. In these patients the mean annual BMC increment was 0.07 g/cm, significantly greater (P < 0.05) than the increment of normal growing children (0.05 g.cm-1.y-1). Our data indicate that although osteoporosis complicates celiac disease during childhood and adolescence, GFD alone is able to remarkably improve bone mineralization.

Effect of estrogen replacement therapy on bone mineral content in girls with Turner syndrome.

Because a close relationship between estrogen deficiency and osteoporosis has been proven, it is possible that lifelong estrogen deficiency might be the cause of osteopenia in Turner syndrome. This study was done to characterize the effect of estrogen therapy on bone mineralization in girls with Turner syndrome. Radial bone mineral content values were found to be below the 95% normal confidence interval in 44 of 49 untreated patients, aged 10.82 +/- 3.45 years. An inverse correlation was found between the patients' ages and their delta bone mineral content values. The effect of beginning estrogen treatment early or late was studied in 16 girls who started the treatment before and 11 who started after age 12. Although they were still deficient compared with controls, the first group had better mineralization than the second (P = .0005). Finally, nine patients were followed prospectively during replacement therapy; their bone mineral content delta values changed significantly (P = .02) during the follow-up period (3.17 +/- 0.33 years), but the bone mineral content did not normalize. Our data show that estrogen deficiency per se does not cause osteoporosis in young girls with Turner syndrome. In fact, estrogen therapy prevented bone loss but failed to normalize the low bone mineral content values. Early treatment is preferable because it reduces the bone density deficit present in untreated patients.

[Measuring the mineral content of the distal radius in the age of growth]. / La mineralometria radiale ultradistale nell'età evolutiva.

A study was carried out to characterize in the growing skeleton the absorptiometric measurement of the ultradistal radial epiphysis where the trabecular bone is higher than at proximal scanning planes. The study showed that a radius scan, 1 to 1.4 cm proximal to the ulnar tip, and consequently 4 to 6 mm proximal to the growing plate, gives reproducible informations in infants aged 6 years or more when the BMC, and not the BMC/BW, is considered, as the measurement error is 3.5% and 5.7%, respectively.

Nephrocalcinosis in children and adolescents: sonographic evaluation during long-term treatment with 1,25-dihydroxycholecalciferol.

In order to study the presence of possible renal damage, 12 patients who had been chronically treated with 1,25-dihydroxycholecalciferol therapy, 1,25(OH)2D3, for hypoparathyroidism, pseudohypoparathyroidism, and hypophosphatemic rickets were examined by renal ultrasound. Two patients had normal values while 10 subjects showed nephrocalcinosis (NC) of mild, medium, or severe degree. The echographic results have been related to some calcium-phosphorus metabolism and therapeutic parameters. In those subjects with medium to severe NC, the age at the beginning of therapy was significantly younger and the dose of 1,25(OH)2D3 was significantly higher, than in the other patients. Laboratory data were not predictive of NC. Renal ultrasound is, therefore, a useful means of screening to detect even early stages of NC; its use in the follow-up is also recommended.