Impaired bone mineral density and microarchitecture in female adolescents with IgE-mediated cow’s milk allergy

Summary This study compared the bone parameters of adolescents with persistent cow’s milk allergy (CMA) with those of healthy adolescents. Adolescents with CMA had compromised bone parameters (lower bone mineral density, impaired trabecular microarchitecture, and lower bone strength). Partial exclusion diet was associated with better bone parameters than total exclusion diet. Background Persistent immunoglobulin E (IgE)–mediated cow’s milk allergy (CMA) may impair bone parameters and increase the risk of fractures. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a novel methodology that not only assesses trabecular and cortical bone compartments and volumetric density measurements, but also evaluates bone microarchitecture and estimates biomechanical properties through finite element analysis (FEA). Both HR-pQCT and bone strength parameters derived from FEA have shown a strong correlation with fracture risk. Purpose To assess the bone density, microarchitecture, and bone strength of adolescents with persistent IgE-mediated CMA (IgE-CMA). Methods This was an observational, cross-sectional study with female adolescents with persistent IgE-CMA and healthy control participants matched by female sex and sexual maturation. Bone parameters were assessed by areal bone mineral density (aBMD) through dual-energy X-ray absorptiometry (DXA), bone microarchitecture by HR-pQCT at the radius and tibia, and laboratory markers related to bone metabolism. Results The median age of adolescents with persistent IgE-CMA ( n = 26) was 13.0 years (interquartile range (IQR) 11.4–14.7) and of healthy control participants ( n = 28) was 13.6 years (IQR 11.9–14.9). Adolescents with IgE-CMA ingested 27.4% less calcium ( p = 0.012) and 28.8% less phosphorus ( p = 0.009) than controls. Adolescents with IgE-CMA had lower bone mineral content (BMC) (38.83 g vs. 44.50 g) and aBMD (0.796 g/cm 2 vs. 0.872 g/cm 2 ) at lumbar spine, and lower BMC (1.11 kg vs. 1.27 kg) and aBMD (0.823 g/cm 2 vs. 0.877 g/cm 2 ) at total body less head (TBLH) ( p