The Ketogenic Diet and Its Effect on Bone Mineral Density: A Retrospective Observational Cohort Study

Jos M.T. Draaisma; Brieke M. Hampsink; Marcel Janssen; Nicole B.M. van Houdt; E. T.A.M. Linders; Michèl A. Willemsen

doi:10.1055/s-0039-1693059

Neuropediatrics, Table of Contents

Neuropediatrics 2019; 50(06): 353-358
DOI: 10.1055/s-0039-1693059

Original Article

Georg Thieme Verlag KG Stuttgart · New York

The Ketogenic Diet and Its Effect on Bone Mineral Density: A Retrospective Observational Cohort Study

Jos M.T. Draaisma

¹Department of Pediatrics, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

,

Brieke M. Hampsink

¹Department of Pediatrics, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

,

Marcel Janssen

²Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

,

Nicole B.M. van Houdt

³Department of Gastroenterology and Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands

,

E. T.A.M. Linders

⁴Department of Pediatric Neurology, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

,

Michèl A. Willemsen

⁴Department of Pediatric Neurology, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

› Author Affiliations

Abstract

Background During long-term follow-up of children treated with the ketogenic diet therapy (KDT) have an increased incidence of bone fractures. However, the exact contribution of KDT to a decreased bone mineral density (BMD) remains unclear.

Objective This study aimed to evaluate (changes in) BMD in children treated with KDT and to evaluate whether intravenous bisphosphonate therapy may be effective.

Design In this retrospective, observational cohort study, all children treated with KDT from 2010 until 2018 at the Radboudumc Amalia Children's hospital were included. Patients who were on KDT for more than 6 months and who had at least two dual-energy X-ray (DXA)-scans were eligible for inclusion for longitudinal analysis. Z-scores of DXA-scans were compared over the course of time.

Results In 34 out of 68 patients, one or more lumbar DXA-scans were performed, with a mean lumbar Z-score of −1.32 ± 1.74. Of these 68 patients, 8.8% got a fracture during KDT, and also 8.8% got kidney stones. In 20 patients, more than one DXA-scan was performed. A statistically not significant decrease in BMD (0.22 Z-score/year) was found. However, there was an increase in BMD in the five patients treated with intravenous bisphosphonate therapy. This was statistically significant in comparison to the nonbisphosphonate treated group (p = 0.034).

Conclusion Children on KDT have low normal BMD which may decrease further during KDT. For this reason monitoring of BMD is crucial, as is monitoring of kidney stones and hypercalciuria. Intravenous bisphosphonate therapy may have a positive effect, when other therapies have failed.

Keywords

ketogenic diet tehrapy - bone mineral density - biphophonate therapy - epilepsy

Full Text

References

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