Background: The Ketogenic Diet Treatment (KDT) is a well-established intervention for intractable childhood epilepsy and the first choice treatment for Gluccose-1-transporter-deficiency-syndrome and Pyruvate-dehydrogenase-complex deficiency. During long-term follow up of children treated with KDT an increased incidence of bone fractures has been found. However, the exact contribution of KDT to a decreased BMD remains unclear. Prophylactic supplementation with calcium and vitamin D is mandatory, but may fail to prevent continued bone mineral density (BMD) loss. Moreover, there is an increased risk of kidney stones. Treatment with bisphosphonates for a decreasing bone mineral density with or without fractures is not yet a regular part of treatment in these children.
Objective: This study aimed to evaluate changes in BMD measured with dual-energy X-ray Absorptiometry (DXA) in children treated with KDT and to evaluate whether treatment with bisphosphonates may be useful.
Methods: In this retrospective cohort study, all children who were treated with KDT from January 1st 2010 until August 1st 2018 at the Radboudumc Amalia Childrens hospital were included. Patients had to have at least two DXA-scans to be eligible for inclusion. Z-scores of DXA-scans were compared over the course of time.
Results: Out of the 68 children who were treated with KDT, 20 patients were included (average time on KDT 39.55 months; range 9100 months). The Z-score at the time of the first DXA-scan was −1.89. patients. A statistically not signoficant decrease in BMD was found. Four patients experienced fractures during KDT. Five patients received bisphosphonate therapy. We found an increased BMD in patients treated with bisphosphonate therapy. This was statistically significant in comparison to the non-bisphosphonate group (P=0.034).
Conclusion: The ketogenic diet itself might be associated with decreased bone mass, and bone health monitoring is important in this high-risk group. Larger studies are required to further explore the relationships between the KDT and BMD, and longer-term follow up is required to determine fracture risk throughout life. Further therapy with bisphosphonate needs to be explored, as our results suggest that this might have a positive effect on bone mineral density
Disclosure: The authors declared no competing interests.