Does dermatitis herpetiformis result in bone loss as coeliac disease does?: a cross sectional study

Abstract

Introduction and objectives: coeliac disease (CD) and its cutaneous manifestation, dermatitis herpetiformis are both (DH) glutensensitive diseases. Metabolic bone disease is common among patients with CD, even in asymptomatic forms. Data are scarce about bone density in patients with dermatitis herpetiformis. The aim of our study was to compare bone mineral density (BMD) of celiac and dermatitis herpetiformis patients.Methods: 34 coeliac patients, 53 with dermatitis herpetiformis and 42 healthy controls were studied. The mean age was 38.0 ± 12.1, 32.18 ± 14.95, 35.33 ± 10.41 years in CD, dermatitis herpetiformis, and healthy controls, respectively. Bone mineral density of the lumbar spine, the left femoral neck and radius were measured by dual-energy X-ray absorptiometry. Low bone density, osteopenia and osteoporosis were defined as a body mass density (BMD) T-score between 0 and -1, between -1 and -2.5, and under -2.5, respectively.Results: at lumbar region, consisting of dominantly trabecular compartment, a decreased BMD was detected in 49 % (n = 26) patients with dermatitis herpetiformis, 62 % (n = 21) of CD patients, and 29 % (n = 12) of healthy controls, respectively. Lower BMD were measured at the lumbar region in dermatitis herpetiformis and CD compared to healthy subjects (0.993 ± 0.136 g/cm 2 and 0.880 ± 0.155 g/cm 2 vs. 1.056 ± 0.126 g/cm 2 ; p < 0.01). Density of bones consisting of dominantly cortical compartment (femoral neck) did not differ in dermatitis herpetiformis and healthy subjects.Conclusions: our results show that a low bone mass is also frequent among patients with dermatitis herpetiformis. Bone mineral content in these patients is significantly lower in those parts of the skeleton which contain more trabecular than cortical bone.

Self-Reported Fractures in Dermatitis Herpetiformis Compared to Coeliac Disease

“…Occasionally gastrointestinal symptoms also occur, but they are often minor [ 9 , 12 ]. It seems presumable that the increased risk of bone fractures would also be associated with DH, but bone complications in DH have been studied scantily and the results are thus far conflicting [ 13 , 14 , 15 , 16 , 17 ]. The only study focusing on the fracture risk in DH found no increase in risk [ 13 ].…”

Bones of Contention: Bone Mineral Density Recovery in Celiac Disease—A Systematic Review

“…And when matched by age and gender to a non-affected population, celiac patients have a 40% greater risk for bone fracture [ 2 ]. Even with a silent or extra-intestinal presentation such as dermatitis herpetiformis or dementia, low bone mass is frequently found [ 3 , 4 , 5 ]. One-third of newly diagnosed cases are over 60 years of age which coincides with a period of an increased risk of falls only worsened by the presence of co-morbidities [ 6 , 7 ].…”

Dermatitis herpetiformis: what lies beneath the skin?

“…It was found that lumbar spine bone mineral content was significantly lower in patients with DH as compared to healthy controls, but higher than in CD patients. In contrast, bone mineral density at the femoral neck and radius of patients with DH was similar to that of healthy controls, whereas subjects with CD also exhibited a significantly reduced bone density in both these sites (18).…”

“…The present issue of the Revista Española de Enfermedades Digestivas includes an original paper by Katalin Lorinczy et al highlighting the transcendence of CD and DH beyond the intestinal and skin lesions themselves (18). The study of bone mineralization in adult patients with DH has been scarcely reported in the literature and results have been inconclusive so far -While some authors find no lower bone mineral density among patients with DH (19), nor an increased risk of fractures versus classic celiac individuals (20) despite the presence of intestinal disease, others have reported significant changes in bone mass in patients with DH, similar to the rest of celiacs, in association with poorer nutritional status (21).…”