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Bone Abstracts (2013) 2 P62 | DOI: 10.1530/boneabs.2.P62

1Department of Endocrinology and Diabetes, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia; 2Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; 3Murdoch Childrens Research Institute, Parkville, Victoria, Australia; 4Department of Neurology, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia; 5Department of Nutrition and Food Services, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia; 6Department of Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia; 7Department of Paediatrics, Austin Health, Heidelberg, Victoria, Australia; 8Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg, Victoria, Australia; 9Florey Neuroscience Institutes, Melbourne, Victoria, Australia.

Objectives: The ketogenic diet (KD) is a medically supervised, high fat, low carbohydrate and restricted protein diet which has been used successfully in patients with refractory epilepsy. Only one published report has explored its effect on the skeleton. We postulated that KD impairs bone mass accrual and examined skeletal health parameters in this patient group.

Methods: Patients commenced on the KD from 2002–2009 were enrolled in a prospective, longitudinal study; with monitoring of dual-energy X-ray absorptiometry (DXA) derived bone parameter including bone mineral content and density (BMD). Areal BMD was converted to bone mineral apparent density (BMAD) where possible. Biochemical parameters, including vitamin D, and bone turnover markers, including osteocalcin and urinary deoxypiridinolone, were assessed.

Results: 29 patients were on the KD for a minimum of 6 months (range 0.5–6.5 years, mean 2.1 years). There was a mean reduction in lumbar spine (LS) BMD Z-score of 0.37 S.D. 20 patients (68%) had a lower BMD at the end of treatment. There was no correlation between change in LS BMD and ambulatory status (R=0.02). Height adjustment was possible for 13 patients, with a mean reduction in BMAD Z-score of 0.19 S.D. ALP levels were in the normal range but osteocalcin showed a mean 26.5 nmol/l, which was elevated. Only one patient sustained fractures (bilateral femoral fractures). Urinary calcium-creatinine ratios were elevated (mean 0.77) but only one patient developed renal calculi.

Conclusion: The KD has a small but significant effect on the developing skeleton, independent of height and ambulatory status. Effects on bone turnover and calcium/creatinine ratios point to abnormal mineral metabolism. Clinicians should be aware of potential skeletal side effects and monitor bone health during KD treatment. Longer term follow up is still required to determine adult/peak bone mass and fracture risk.

Volume 2

6th International Conference on Children's Bone Health

Rotterdam, The Netherlands
22 Jun 2013 - 25 Jun 2013


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