International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: http://www.sciepub.com/journal/ijcd Editor-in-chief: Samasca Gabriel
Open Access
Journal Browser
Go
International Journal of Celiac Disease. 2017, 5(4), 155-158
DOI: 10.12691/ijcd-5-4-7
Open AccessCommentary

Understanding the Variation in Use of Screening DXA Scans in Pediatric Patients with Celiac Disease

Jennifer Webster1, , Kathy Shaw1, 2, Judy Shea2, April Taylor1 and Ritu Verma1

1The Children’s Hospital of Philadelphia, United States

2University of Pennsylvania Perelman School of Medicine, United States

Pub. Date: November 24, 2017

Cite this paper:
Jennifer Webster, Kathy Shaw, Judy Shea, April Taylor and Ritu Verma. Understanding the Variation in Use of Screening DXA Scans in Pediatric Patients with Celiac Disease. International Journal of Celiac Disease. 2017; 5(4):155-158. doi: 10.12691/ijcd-5-4-7

Abstract

Celiac disease (CD) is an immune-mediated genetic disorder occurring secondary to gluten exposure and increasing the likelihood of low bone mineral density (BMD). As there are no published guidelines for dual-x-ray absorptiometry (DXA) scanning in pediatric CD patients, we characterized current practices of pediatric gastroenterologists in ordering screening DXA scans for pediatric CD patients. To accomplish this, A REDCap survey was distributed to the NASPGHAN listserv. There was a total of 231 (11%) responses. The majority (60%) of clinicians do not order screening DXA scans because they don’t believe it is clinically necessary. Patient factors influenced ordering screening DXA scans with fracture history driving ordering and tissue transglutaminase (tTG) level not affecting practice. Physician factors such as practice type and experience were not associated with ordering screening DXA scans. Case scenarios, showed wide variation in management based on DXA results.

Keywords:
celiac disease bone survey guidelines pediatric

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Fasano, A, Catassi, A. “Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum”, Gastroenterology, 120(3). 636-651. February 2001.
 
[2]  Ludvigsson JF, Rubio-Tapia A, Van Dyke CT, et al. “Increasing incidence of celiac disease in a North American population”, Am J Gastroenterol, 108(5). 818-824. May 2013.
 
[3]  Jatla, M, Zemel, B, Bierly, P, Verma, R. “Bone Mineral Content Deficits of the Spine and Whole Body in Children at Time of Diagnosis With Celiac Disease”, J Pediatr Gastroenterol Nutr, 48(2). 175-180. February 2009.
 
[4]  Krupa-Kozak, U. “Pathologic bone alterations in celiac disease: Etiology, epidemiology, and treatment”, Nutrition, 30(1). 16-24. January 2014.
 
[5]  Jansen M, van Zelm M, Groeneweg M, et al. “The identification of celiac disease in asymptomatic children: the Generation R Study”, J Gastroenterol, 1-0. June 2017.
 
[6]  Margoni, D, Chouliaras, G, Duscas, G, et al. “Bone Health in Children With Celiac Disease Assessed By Dual X-ray Absorptiometry: Effect of Gluten-free Diet and Predictive Value of Serum Biochemical Indices”, Gastroenterology, 54(5). 680-684. May 2012.
 
[7]  Barera, G, Beccio, S, Carla Proverbio, M, Mora S. “Longitudinal changes in bone metabolism and bone mineral content in children wiht celiac disease during consumption of a gluten-free diet”, Am J Clin Nutr 79(1). 148-154. January 2004.
 
[8]  Mora, S. “Celiac disease in children: impact on bone health”, Rev Endocr Metab Disord, 9(2). 123-30. June 2008.
 
[9]  Olmos, M, Antelo, M, Vazquez, H, Smecuol, E, Maurino, E, Bai, JC. “Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease”, Dig Liver Dis, 40(1). 46-53. January 2008.
 
[10]  Green, P, Cellier, C. “Celiac disease”, N Engl J Med, 357(17). 1731-1743. October 2007.
 
[11]  Tau, C, Mautalen, C, De Rosa, S, Roca, A, Valenzuela, X. “Bone mineral density in children with celiac disease. Effect of a Gluten-free diet.”, Eur J Clin Nutr, 60(3). 358-363. March 2006.
 
[12]  Heyman, R., Guggenbuhl, P, Corbel, A, et al. “Effect of a gluten-free diet on bone mineral density in children with celiac disease”, Gastroenterol Clin Biol, 33(2). 109-114. February 2009.
 
[13]  Kalayci Gazi, A, Kansu, A, Girgin, N, Kucuk, O, Aras, G. “Bone Mineral Density and Importance of a Gluten-Free Diet in Patients With Celiac Disease in Childhood”, Pediatrics, 108(5): 1-5. June 2001.
 
[14]  Lewis, N, Scott, BB. “Should patients with coeliac disease have their bone mineral density measured?”, Eur J Gastroenterol Hepatol, 17(10). 1065-1070. October 2005.
 
[15]  Vazquez, H, Mazure, R, Gonzalez, D. “Risk of Fractures in Celiac Disease Patients: A Cross-Sectional, Case-Control Study”, Am J Gastroenterol, 95(1). 183-189. January 2009.
 
[16]  Scott, E, Scott BB. “A strategy for osteoporosis in gastroenterology”, Eur J Gastroenterol Hepatol, 10(8). 689-696. August 1998.
 
[17]  Fouda, M, Khan, AA, Sultan, M, Rios LP, McAssey K, Armstrong, D. “Evaluation and management of skeletal health in celiac disease: Position statement” Can J Gastroenterol, 26(11). 819-829. November 2012.
 
[18]  Bolland, M, Grey, A, Rowbotham, DS. “Outcomes of bone density measurements in coeliac disease”, N Z Med J, 129(1429). 40-44. January 2016.
 
[19]  Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. “Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support” J Biomed Informm 42(2). 377-81. April 2009.
 
[20]  Hill ID, Dirks MH, Liptak GS, et al. “Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition”, J Pediatr Gastroenterol Nutr, 40(1). 1-19. January 2005.