Osteoporosis in treated adult coeliac disease.

Abstract

Forty five women and 10 men with coeliac disease diagnosed in adult life, who were already on a gluten free diet, had serial bone mineral density measurements at the lumbar spine and femoral neck over 12 months. Osteoporosis, defined as a bone mineral density (BMD) ',2 SD below the normal peak bone mass was found in 50° suggest that reduced bone mineral density is common at presentation.9 10 We therefore studied the prevalence of osteoporosis in asymptomatic adults with treated coeliac disease, and utilised serial bone mineral density measurements to detect any change in bone mineral density over 12 months. SubjectsFifty five patients (45 women and 10 men) with coeliac disease diagnosed in adult life (-18 years old at the time of diagnosis) and already established on a gluten free diet were recruited to the study from the gastroenterology outpatients department at the Royal United Hospital, Bath between 24 September 1991 and 21 October 1992. Coeliac disease was defined as small intestinal malabsorption associated with the characteristic small intestinal mucosal lesion together with clinical and histological improvement on a gluten free diet. 1 'The average age of the men was 50.2 years (range 27.0-65.0 years) and that of the women was 51-3 years (range 33.6-69.1 years). With regard to the women, the average age at menarche was 14 years (range 10-20 years; five patients had menarche at age 16 years or older). Five women (no overlap with the delayed menarche group) had a history of an episode of premenopausal amenorrhoea of at least six months. Sixteen women were premenopausal, 11 were perimenopausal, and 18 were postmenopausal (average age at menopause was 46.3 years, range 34 to 57 years, eight patients had had the menopause at age less than 45 years).Seven patients had been previously treated with oral vitamin D preparations, six had been on glucocorticoids in the past, and five of the women were either on, or had previously been on, hormone replacement therapy for more than 12 months. Fourteen patients (two men) had a history of a serious fracture (rib, clavicle, ankle, forearm, sternum, scaphoid).The average weight of the women was 61-7 kg (range 35-92.7 kg) and that of the men was 74.5 kg (range 55-97 kg). The average height of the women was 1.62 m (range 1A40-1.75 m) and that of the men was 1.74 m (range 1-60-1-86 m). The mean times spent on a gluten free diet were 4.25 years (range 0-4-10 years) in men and 9.2 years (range 0.3-40 years) in women. MethodsA dietary assessment was performed, based on a 10 day weighed record'2 of all food consumed, and the dietary intakes of calcium,

Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County, Minnesota

“…Most significantly, the increase in fracture risk persists after the diagnosis of celiac disease. This suggests the bone disease at diagnosis is often sufficiently advanced as to preclude a return to health even with subsequent diet restriction and medical management [47][48][49]. It is also possible that the persistent risk of fractures is due to other factors such as muscle weakness or neurologic disturbance, though that would not necessarily explain the trend for increased frequencies of spontaneous and axial fractures in the celiac cases.…”

Reduced bone mineral density after surgical treatment for obesity

“…It has been documented in 47% of patients with treated adult coeliac disease. 16 Conversely, coeliac disease is found in at least 3% of patients referred for osteoporosis. 17 Recent studies indicate that treatment with a gluten-free diet probably protects against bone loss and, in the early stages, is associated with a gain in BMD.…”

Celiac disease: diagnostic criteria in progress

“…Thanks to the increased frequency of early CD diagnosis, this form is less and less often observed; however, some patients can still present with wasting cachexia characterized by muscle atrophy and cramps, severe hypoalbuminemia and electrolyte and metabolic disturbances, leading to hypocalcemic tetany and spontaneous bone fractures from marked osteoporosis. 27,28,33 In the subclinical form, gastrointestinal manifestations can be mild or absent and are often completely overshadowed by extra-intestinal symptoms, especially in those patients with a mild mucosal lesion confined to the proximal small intestine. Patients in this group have an isolated iron-deficient anemia, 34 unexplained folic acid deficiency and a hemorrhagic syndrome caused by vitamin K deficiency.…”