Bone Mineral Density Changes in Children with Celiac Disease
Abstract
Background: Celiac disease is a chronic immune-mediated disorder associated with intestinal malabsorption and multiple extraintestinal complications, including impaired bone health. Children with celiac disease are at increased risk of reduced bone mineral density due to nutritional deficiencies and chronic inflammation. Objective: To evaluate bone mineral density changes in children with celiac disease and identify factors associated with reduced bone health. Methods: This cross-sectional analytical study was conducted at Farooq Hospital Lahore from January 2025 to January 2026 including 140 children diagnosed with celiac disease. Results: The mean age of participants was 9.8 ± 3.7 years, with females comprising 55.7% of cases. Mean DEXA Z-score was -1.9 ± 0.9. Osteopenia and osteoporosis were identified in 61 (43.6%) and 27 (19.3%) children, respectively. Children with reduced bone mineral density had significantly lower BMI (15.6 ± 2.3 vs. 17.5 ± 2.1 kg/m²; p<0.001) and lower vitamin D levels (16.9 ± 6.8 vs. 24.1 ± 6.2 ng/mL; p<0.001). Poor dietary compliance and growth retardation were significantly associated with reduced bone mineral density. Logistic regression analysis identified vitamin D deficiency (aOR 3.42; p=0.001), growth retardation (aOR 3.11; p=0.004), and poor dietary compliance (aOR 2.89; p=0.009) as significant predictors of reduced bone mineral density. Conclusion: Reduced bone mineral density is highly prevalent among children with celiac disease and is strongly associated with nutritional deficiencies and poor dietary adherence. Early diagnosis and effective nutritional management are essential to improve skeletal health outcomes.