Year 2016 / Volume 108 / Number 2
Original
Impact of a gluten-free diet on bone mineral density in celiac patients

84-88

DOI: 10.17235/reed.2015.3953/2015

Lorete M.S. Kotze, Thelma Skare, Antonella Vinholi, Leandro Jurkonis, Renato Nisihara,

Abstract
Background: Osteoporosis (OP) is a metabolic bone illness that may complicate celiac disease (CD). It can lead to devastating consequences because of low bone mass and fragility fractures. Purpose: To study the OP prevalence in a group of Brazilian patients with CD and the value of a gluten free diet (GFD). Methods: Retrospective study of celiac female patients from a single University Center followed with bone densitometries. Results from densitometry made at first visit were compared with a second study after a median time of 5 years. During this period, patients were submitted to a GFD according to orientations from special program training. Calcium and vitamin D were prescribed to those patients who did not reach the minimal daily requirement through diet. Results: Forty-one celiac female patients, mean age 46.1 ± 14.8 years, were included. The prevalence of osteopenia at first visit was 56.1% and that of osteoporosis 29.2%. Osteoporosis was associated with longer disease duration (p = 0.01). The second densitometry was performed in a median time of 5 years (range 1 to 13 years) and disclosed 58.9% osteopenia and 28.2% osteoporosis. The GFD improved bone mass, mainly at (of) spine (comparison of T score with p = 0.03 and of bone mass in g/cm2 with p = 0.02), but it was not sufficient to reduce the number of osteopenic (p = 0.9) and osteoporotic patients (p = 0.4). During the follow up period 25% of osteoporotic patients developed low impact fractures. Conclusion: Bone health is notably impaired at baseline in CD patients, especially in those with a diagnostic delay. A GFD modestly improved bone mass density with low impact fractures occurring in one third of patients during the follow up period.
Share Button
New comment
Comments
No comments for this article
References
1. Stazi AV, Trinti B. Risk of osteoporosis in endocrine disorders and celiac disease. Ann Ist Super Sanità 2007; 43: 430-3.
2. Olmos M, Antelo M, Vazquez H, et al. Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease. Dig Liver Dis 2008; 40: 46–53.
3. Larussa T, Suraci E, Nazionale I, et al. Bone mineralization in celiac disease. Gastroenterol Res Pract. 2012;2012:198025.
4. Fiore CE, Pennisi P, Ferro G, et al. Altered osteoprotegerin/RANKL ratio and low bone mineral density in celiac patients on long-term treatment with gluten-free diet. Horm Metab Res. 2006; 38:417-22.
5. Selby PL, Davies M, Adams JE, et al. Bone loss in celiac disease is related to secondary hyperparathyroidism. J Bone Miner Res. 1999 14:652-7.
6. Tau C, Mautalen C, De Rosa S, et al. Bone mineral density in children with celiac disease. Effect of a Gluten-free diet Eur J Clin Nutr. 2006; 60: 358-63.
7. Pantaleoni S, Luchino M, Adriani A, et al. Bone mineral density at diagnosis of celiac disease and after 1 year of gluten-free diet. Scientific World Journal. 2014; 2014: 173082.
8. Di Stefano M, Mengoli C, Bergonzi M, et al. Bone mass and mineral metabolism alterations in adult celiac disease: pathophysiology and clinical approach. Nutrients 2013; 5: 4786-99.
9. Kalayci AG, Kansu A, Girgin N, et al. Bone mineral density and importance of a gluten-free diet in patients with celiac disease in childhood. Pediatrics 2001;108:E89.
10. Mazure R, Vazquez H, Gonzalez D, et al. Bone mineral affection in asymptomatic adult patients with celiac disease. Am J Gastroenterol. 1994; 89: 2130–4
11. Ciacci C, Maurelli L, Klain M, et al. Effects of dietary treatment on bone mineral density in adults with celiac disease: Factors predicting response. Am J Gastroenterol 1997; 92: 992-6.
12. Newnham ED, Shepherd SJ, Strauss BJ, et al. Adherence to the gluten-free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A five-year longitudinal study from diagnosis. J Gastroenterol Hepatol. 2015 Jul 24. doi: 10.1111/jgh.13060. [Epub ahead of print]
13. Piodi L, Poloni A, Ulivieri F. Managing osteoporosis in ulcerative colitis: something new? World J Gastroenterol.2014;20:14087-98.
14. World Gastroenterology Organization. Practice guidelines: Celiac Disease. 2005. Available at http://www.worldgastroenterology.org/assets/downloads/pt/pdf/guidelines/celiac_disease_pt.pdf>
15. FRAX ® WHO Fracture Risk Assessment Tool. Available at: https://www.shef.ac.uk/FRAX/tool.aspx?country=55 (Accessed on March 09, 2015).
16. Lee SK, Green PH. Celiac sprue (the great modern-day imposter). Curr Opin Rheumatol. 2006; 18: 101-7.
17. Pazianas M, Butcher GP, Subhani JM, et al. Calcium absorption and bone mineral density in celiacs after long term treatment with gluten-free diet and adequate calcium intake. Osteoporos. Int. 2005, 16: 56–63.
18. Di Stefano M, Mengoli C, Bergonzi M, et al. Bone Mass and Mineral Metabolism Alterations in Adult Celiac Disease: Pathophysiology and Clinical Approach Nutrients 2013, 5: 4786-99.
19. Valdimarsson T, Toss G, Löfman O, et al. Three years follow-up of bone density in adult coeliac disease: Significance of secondary hyperparathyroidism. Scand J Gastroenterol. 2000; 35: 274–80.
20. Jahnsen J, Falch JA, Mowinckel P, et al.. Vitamin D status, parathyroid hormone and bone mineral density in patients with inflammatory bwel disease. Scand J Gastroenterol 2002; 37: 192-9.
21. Colston KW, Mackay AG, Finlayson C, et al. Localization of vitamin D receptor in normal human duodenum and in patients with coeliac disease. Gut 1994; 35: 1219-25.
22. Lucendo AJ, García-Manzanares A. Bone mineral density in adult coeliac disease: An updated review. Rev Esp Enferm Dig (Madrid) 2014; 105: 154-62.
23. Fornari MC, Pedreira S, Niveloni S, et al. Pre- and post-treatment serum levels of cytokines IL-1beta, IL-6, and IL-1 receptor antagonist in celiac disease. Are they related to the associated osteopenia? Am J Gastroenterol 1998, 93: 413-8.
24. Riches PL, McRorie E, Fraser WD, et al. Osteoporosis associated with neutralizing autoantibodies against osteoprotegerin. N. Engl. J. Med. 2009, 361: 1459–65.
25. Larussa T, Suraci E, Nazionale I, et al. No evidence of circulating autoantibodies against osteoprotegerin in patients with celiac disease. World J. Gastroenterol. 2012, 18, 1622–7.
26. Romaldini CC1, Barbieri D, Okay TS, et al. Serum soluble interleukin-2 receptor, interleukin-6, and tumor necrosis factor-alpha levels in children with celiac disease: response to treatment. J Pediatr Gastroenterol Nutr. 2002; 35: 513-7.
27. Lemieux B, Boivin M, Brossard JH, et al. Normal parathyroid function with decreased bone mineral density in treated celiac disease. Can J Gastroenterol. 2001; 15:302-7.
28. Hall N, Rubin G, Charnock A. Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther. 2009; 30:315-30.
29. See JA, Kaukinen K, Makharia GK, et al. Practical insights into gluten-free diets. Nat Rev Gastroenterol Hepatol. 2015 Sep 22. doi: 10.1038/nrgastro.2015.156. [Epub ahead of print]
Related articles

Letter

Liver disorders and celiac disease

DOI: 10.17235/reed.2023.9516/2023

Digestive Diseases Image

Calcified cavitating mesenteric lymph node syndrome: a rare complication of celiac disease

DOI: 10.17235/reed.2020.7494/2020

Letter

Balanced by iron. Hereditary hemochromatosis and celiac disease

DOI: 10.17235/reed.2020.7269/2020

Review

New celiac disease biomarkers

DOI: 10.17235/reed.2020.7217/2020

Editorial

Is celiac disease really associated with inflammatory bowel disease?

DOI: 10.17235/reed.2019.6779/2019

Original

Coping with celiac disease: how heavy is the burden for caregivers?

DOI: 10.17235/reed.2017.4518/2016

Letter to the Editor

Celiac disease and fibromyalgia: Is there an association?

DOI: 10.17235/reed.2015.3992/2015

Citation tools
Kotze L, Skare T, Vinholi A, Jurkonis L, Nisihara R. Impact of a gluten-free diet on bone mineral density in celiac patients. 3953/2015


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 2783 visits.
This article has been downloaded 125 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 04/08/2015

Accepted: 21/11/2015

Online First: 10/12/2015

Published: 01/02/2016

Article revision time: 91 days

Article Online First time: 128 days

Article editing time: 181 days


Share
This article has been rated by 1 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology