CELIAC DISEASE;

EFFECTIVENESS OF TREATING PREVIOUSLY UNTREATED PATIENTS WITH BOTH A GLUTEN FREE DIET AND BISPHOSPHONATE, GLUTEN FREE DIET ALONE.

Abstract

Objective: To evaluate effectiveness of treating previously untreated patients with
celiac disease with both a gluten free diet and bisphosphonate in order to significantly increase
their BMD’s to a greater extent than a gluten free diet alone. Patients and methods: The study
was conducted in National Institute of Child Health (NICH) Karachi to evaluate the effectiveness of
treating previously untreated patients with celiac disease with a gluten free diet and
bisphosphonate in terms of increase in bone mineral density in comparison to a gluten free diet
alone over a period of three months (January 2013 – March 2013). The study includes 30 children
patients below fifteen years of age either sex. All study subjects were untreated celiac patients
diagnosed by clinical presentation, small bowel histology and serologic testing. On day dexa
scan was done. Fifteen patients kept on Gluten Free Diet (GFD) and remaining 15 patients kept
GFD plus tablet of bisphosphonate. After three months dexa scan was repeated. The patients
with other disease of bone or mineral metabolism, as well as subjects taking systemic
glucocorticoids or high doses of thyroid hormones, were excluded. Results: A total of 30 patients
with celiac disease were included in this study. Out of 30 patients 18 (60%) were female and 12
(40%) male (M: F = 1:1.5). Thirty patients were divided in two equal groups (15 patients in each
group). In group-I we gave gluten free diet and in group-II we gave gluten free diet and one tablet
of bisphosphonate. Mean± SD of Bone Mineral Density (BMD) in group-I was 0.402± 0.081
gm/cm2 (range=0.234 – 0.503 gm/cm2), and in group-II was 0.543± 0.098 gm/cm2 (range=
0.402 – 0.743 gm/cm2), mean difference of bone mineral density was significant between two
groups (P-value=0.0002). Conclusions: At three months DEXA scan showed a significant rise in
BMD in group-II as compared to group-I