Pancheva Ruzha, Dyankova Yoana, Rasheva Niya, Koleva Krassimira, Iotova Violeta, Dzhogova Mariya, Fiore Marco, Georgieva Miglena
Department of Hygiene and Epidemiology, Faculty of Public Health, Prof. Dr. Paraskev Stoyanov Medical University, 9000 Varna, Bulgaria.
Department of Pediatrics, Faculty of Medicine, Prof. Dr. Paraskev Stoyanov Medical University, 9000 Varna, Bulgaria.
Nutrients. 2025 Jul 11;17(14):2295. doi: 10.3390/nu17142295.
Celiac disease (CD) impairs bone development in children through inflammation and nutrient malabsorption. Osteoprotegerin (OPG), a decoy receptor for RANKL, plays a role in bone remodeling and is increasingly recognized as a potential biomarker of bone metabolism and inflammation. However, its clinical significance in pediatric CD remains unclear. To evaluate the relationship between OPG levels, growth parameters, and delayed bone age in children with CD, and to assess OPG's potential as a biomarker of bone health and disease activity. This three-year case-control study included 146 children: 25 with newly diagnosed CD (Group A), 54 with established CD on a gluten-free diet (Group B), and 67 healthy controls (Group C). Participants underwent clinical, anthropometric, and laboratory assessments at baseline and after 6 months (Groups A and B). OPG and osteocalcin were measured, and bone age was assessed radiologically. Statistical analyses included ANOVA, Spearman's correlations, and binomial logistic regression. OPG levels were highest in newly diagnosed children (Group A), showing a non-significant decrease after gluten-free diet initiation. OPG correlated negatively with age and height in CD patients and controls, and positively with hemoglobin and iron in Group B. Logistic regression revealed no significant predictive value of OPG for delayed bone age, although a trend was observed in Group B ( = 0.091). Children in long-term remission exhibited bone maturation patterns similar to healthy peers. OPG levels reflect disease activity and growth delay in pediatric CD but lack predictive power for delayed bone age. While OPG may serve as a secondary marker of bone turnover and inflammatory status, it is not suitable as a standalone biomarker for skeletal maturation. These findings highlight the need for integrative biomarker panels to guide bone health monitoring in children with CD.
乳糜泻（CD）通过炎症和营养吸收不良损害儿童骨骼发育。骨保护素（OPG）是核因子κB受体活化因子配体（RANKL）的诱饵受体，在骨重塑中起作用，并且越来越被认为是骨代谢和炎症的潜在生物标志物。然而，其在儿童CD中的临床意义仍不清楚。为了评估OPG水平、生长参数与CD患儿骨龄延迟之间的关系，并评估OPG作为骨骼健康和疾病活动生物标志物的潜力。这项为期三年的病例对照研究纳入了146名儿童：25名新诊断为CD的儿童（A组），54名采用无麸质饮食的确诊CD儿童（B组），以及67名健康对照儿童（C组）。参与者在基线时以及6个月后（A组和B组）接受了临床、人体测量和实验室评估。测量了OPG和骨钙素，并通过放射学评估骨龄。统计分析包括方差分析、Spearman相关性分析和二项逻辑回归。新诊断儿童（A组）的OPG水平最高，开始无麸质饮食后呈非显著性下降。在CD患者和对照组中，OPG与年龄和身高呈负相关，在B组中与血红蛋白和铁呈正相关。逻辑回归显示，OPG对骨龄延迟没有显著预测价值，尽管在B组中观察到一种趋势（P = 0.091）。长期缓解的儿童表现出与健康同龄人相似的骨骼成熟模式。OPG水平反映了儿童CD中的疾病活动和生长延迟，但对骨龄延迟缺乏预测能力。虽然OPG可能作为骨转换和炎症状态的次要标志物，但它不适合作为骨骼成熟的独立生物标志物。这些发现强调了需要综合生物标志物面板来指导CD患儿的骨骼健康监测。
