Text Box: BIOCHEMICAL BONE TURNOVER IN PATIENTS WITH CELIAC DISEASE ON DIET WITH TRACE AMOUNTS OF GLUTEN
Hozyasz K, Gajewska J, Rowicka G, Ambroszkiewicz J, Milanowski A
Dept. of Pediatrics and Dept. of Biochemistry, National Research Institute of Mother and Child, Warsaw, Poland

It has been known for many years that active coeliac disease (CD) predisposes patients to derangements of bone. However, little information is available on biochemical bone turnover markers in children with this metabolic disease. 
The aim of this study was the investigation of two formation markers: serum bone alkaline phosphatase (BALP) and serum bone gla protein (BGP), and one resorption marker: C-terminal telopeptides of type-1 collagen (Ctx) in pediatric celiac patients receiving a gluten-free diet (GFD) based on products with trace amouts of gluten: „gluten-free” wheat starch, flavourised cornflakes,  etc. 
Material and Methods: We studied 15 patients (ages 2-17y.) with CD and 50 clinically healthy subjects with similar ages to these celiac group. The patients reported rare gluten ingestion (less than 2-3 times/year), 4 of them had trace IgAEMA titers. They denied any clinical symptoms consistent with a diagnosis of active CD. The avtivity of BALP was measured using an enzyme immunoassay – Alphase-B kit (Metra Biosystems, USA). The levels of BGP and Ctx were determined respectively by N-MID Osteocalcin One Step ELISA kit and Serum CrossLaps One Step ELISA (Osteometer Bio Tech, Denmark). 
Results: We observed the higher activity of BALP in younger patients in comparison to the age-matched healthy children. On the contrary, the levels of BGP and Ctx in children with CD were lower than in controls. No significant difference was found between two groups of celiacs without IgAEMA and with trace titers of this antibodies. Further studies are needed to evaluate both: 1.the efficiency of „a no detectable gluten diet” and  GFD in accordance with Codex Alimentarius (with trace amounts of gluten) in children with CD and  2.the clinical usefulness of bone turnover biochemical markers for the assessement of therapeutic response.
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