Osteoporosis in celiac disease and in endocrine and reproductive disorders

Abstract

As the increase in lifespan brings to light diseases that were previously not clinically detectable, osteoporosis has become an issue of worldwide significance. The disease is marked by a loss of bone mass; the bones become less dense, fragile and more prone to fracturing. Because it is regulated by endocrine and environmental factors, osteoporosis presents a multifactorial etiopathogenesis, with the genetic component accounting for 70% of an individual variation in bone mass density (BMD), the principal determinant, with age, of fracture risk. Pathological conditions such as celiac disease (CD) exacerbate the process of bone loss, so that the occurrence of osteoporosis in celiac subjects is of particular note: indeed, the screening of osteoporosis patients for this disease is advisable, since it may be the only sign of undiagnosed CD. An increase in interleukin IL-1beta, of the IL-1 system, in the relatives of celiac patients confirms the genetic predisposition to osteoporosis and its presence is evidence of an association between the two conditions. The direct effect on the bones of CD is secondary to poor absorption of calcium and vitamin D. In women osteoporosis is indirectly associated with early menopause and amenorrhea, and it may follow prolonged breast-feeding and frequent pregnancies, while in men it is associated with hypogonadism and GH deficit. These endocrine and non-endocrine factors exert their effects on bones by modulating the RANK/RANK-L/OPG system. An appropriate lifestyle from adolescence onwards, together with early diagnosis of and treatment for CD and primary and secondary endocrine pathologies are important for the prevention of damage to the bones.

Celiac disease screening in Brazilian patients with osteoporosis

“…Metabolic bone disease in patients with CD is common and multifactorial (2,4,9). Calcium and vitamin D malabsorption with secondary rise in PTH is one of the Celiac disease and osteoporosis causes (14).…”

“…They elevate bone reabsorption due to amplified osteoclast activation and survival (16). Also, clinical and subclinical hypogonadism have been found in CD patients of both genders (17). While most authors agree that bone health is a problem in CD, and that there is an increased rate of fragility fracture in this group of patients (4,10), there is not a clear recommendation as to which OP patients should be screened for CD.…”

“…OP prevalence in CD patients is higher than in the whole population (2,9), and may occur even in those with subclinical disease. A metanalysis by Olmos and cols.…”

“…It is a multifactorial disorder influenced by genetic (70%) and environmental factors (30%) (1). With the recent increase in life expectancy, OP has become a public health problem with considerable economic and social importance (2). The Brazilian Osteoporosis Study (3), published in 2009, identified clinical risk factors associated with fragility fractures and OP in the Brazilian population.…”

“…), and use of drugs such as glucocorticoids, antipsychotics, and others (4). Patients with diseases such as hyperparathyroidism, thyrotoxicosis, and celiac disease (CD) have increased risk of OP (2). However, few studies have evaluated the prevalence of OP and the clinical risk factors associated with this condition in Latin America, and particularly in Brazil.…”