24 Monitoring bone health in children and young people with coeliac disease – a clinical audit. (30th November 2020)

• Record Type: Journal Article
• Authors: Khweir, Sarah; Kiparissi, Fevronia; Gaynor, Edward
• Is Part Of: Archives of disease in childhood. Volume 105(2020)Supplement 2
• Page Start: A8
• Page End: A8
• Publication Date: 2020-11-30
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2020-gosh.24
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Introduction: Monitoring of bone health via bone density in coeliac disease (CD) using dual–energy X–ray absorptiometry (DEXA) in childhood is recognised in clinical practice, however there is variance in frequency of monitoring. At Great Ormond Street Hospital (GOSH) the coeliac protocol is to perform a DEXA after diagnosis. National guidelines are non-specific about the paediatric population. This audit explored whether children with CD are meeting current guidance of DEXA scan monitoring at GOSH and whether those who have had DEXA scans had a change in their management. Methods: Retrospective clinical audit, registered with the research and development team. Data collected via electronic patient records (EPR) April 2020 on all patients seen in the dietetic led coeliac clinic. Results: 31 patients in dietetic led coeliac clinic. Median age at diagnosis was three years. 87% patients had a DEXA scan, of which 81% of were normal. Scans were performed a median 3.5 years after diagnosis. 2/5 patients with abnormal DEXA had tTGA's of 8–12.5U/ml. BMAD z-scores were completed in 78% of patients with mean -0.27. Serum levels of vitamin D were>25 nnmol/L in 100% patients but 45 nmol-60 nmol/L in children with abnormal DEXA. No child had faltering growth at time of DEXA. Conclusions: As children are being diagnosed early, and there is a reversal in low bone mineral density on a gluten free diet, there are fewer indications to measure DEXA routinely. DEXA should therefore be only reserved for 'at risk' groups. Vitamin D supplementation of 10 ug daily and annual monitoring should be routinely advised.