Stratification of bone fracture risk in patients with celiac disease

Moreno, María Laura; Vázquez, Horacio; Mazure, Roberto M.; Smecuol, Edgardo; Niveloni, Sonia I.; Pedreira, Silvia C.; Sugai, Emilia; Mauriño, Eduardo; Gómez, Juan Carlos; Bai, Julio C.

doi:10.1016/s1542-3565(03)00320-3

Cited by 77 publications

(61 citation statements)

References 15 publications

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“…In the United States BMD was normal in only 25% of patients with CD, 45% presenting more than one standard deviation below age matched controls (51) . Men were more severely affected than women.…”

Section: Bone Diseasementioning

confidence: 94%

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Celiac disease in Brazilian patients: associations, complications and causes of death. Forty years of clinical experience

Kotze

2009

Arq. Gastroenterol.

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-Context -Celiac disease is a multisystem auto-immune disorder and may start at any age in genetically predisposed individuals. Objective -To identify associations, complications, and cause of death in Brazilian patients. Methods -One hundred and fifty-seven patients were studied: 23 adolescents and 134 adults, 79.6% females, 20.4% males, 75.8% at the time of diagnosis and 24.2% on a gluten-free diet, follow-up between 1 and 40 years. The diagnosis of celiac disease was based on histologic findings and the presence of serologic auto-antibodies markers for celiac disease. Specific tests were done according to clinical suspicion of associations. Bone mineral density was determined by dual energy x-rays in 53 patients upon diagnosis. The data regarding associations, complications, and causes of death were obtained by interviews and from the patient's charts. -Results -Associations: atopy (22.3%), depression (17.2%), thyroid disorder (15.9%), dermatitis herpetiformis (11.5%), diabetes mellitus types 1 and 2 (4.5%) and tumors (4.5%). Complications -Anemia and osteopenia/osteoporosis in all groups; increased number of spontaneous abortion. Four patients (4.5%) died (one from lymphoma, one with diabetes type 1, one from acute meningitis and one due to suicide). Conclusions -This experience is similar to those described in the world literature. Celiac disease presents the same characteristics independently of the geographic region. We recommend periodic evaluations, from childhood, independent of the duration of the diet. The key is to establish an interval between evaluations. HEADINGS -Celiac disease. Gluten. Lymphoma, non-Hodgkin.

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Section: Bone Diseasementioning

confidence: 94%

“…Calcium malabsorption with hyperparathyroidism, malabsorption of vitamin D, increased inflammatory cytokines (IL-1 and IL-6) play a strong role in bone resorption and are therefore important factors to be considered. Bone fractures are a consequence of bone weakness related to the severity of CD activity (51) .…”

Section: Bone Diseasementioning

confidence: 99%

Celiac disease in Brazilian patients: associations, complications and causes of death. Forty years of clinical experience

Kotze

2009

Arq. Gastroenterol.

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“…Whereas adult patients with type 1 diabetes and unknown serologic status for celiac autoimmunity have been shown to be at increased risk of bone fractures regardless of gender [16,29], that risk appears to be only slightly increased in an heterogeneous population in which most individuals had CD diagnosed in adulthood [30]. Additionally, the risk of fractures has been shown to vary according to the type of clinical presentation of CD, being more frequent in typical cases [31]. The clinical significance of the BMD reduction herein reported and the power of the association between CD and type 1 diabetes in adolescent patients to increase the risk of bone fractures later in life remain to be ascertained.…”

Section: Discussionmentioning

confidence: 99%

Bone Mineralization in Young Patients with Type 1 Diabetes Mellitus and Screening-identified Evidence of Celiac Disease

et al. 2007

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The aims of this study were to evaluate bone mineral density (BMD) and bone turnover markers in patients with type 1 diabetes and screening-identified evidence of celiac disease, i.e., celiac autoimmunity. We screened 50 consecutive type 1 diabetic patients for IgA antitissue transglutaminase to identify those with celiac autoimmunity. Eight seropositive patients were identified on this screening, and 12 patients matched for gender and age range were selected as a control group from among the type 1 diabetic patients without celiac autoimmunity. Patients and controls underwent dual-energy X-ray absorptiometry (DEXA) for measurement of bone mineral status and had their blood levels of osteocalcin, carboxy-terminal telopeptide of type I collagen (CTX), calcium, and phosphorus determined. BMD was further adjusted for height, weight, and pubertal stage. Radiographic and blood markers of bone mineralization were compared between patients and controls. BMD (Z-score) at the lumbar spine was -1.44 +/- 0.5 SD for patients and 0.04 +/- 0.2 SD for controls (P = 0.02). Bone mineral content was 37.9 +/- 4.5 g for patients and 49.4 +/- 2.6 g for controls (P = 0.049). Adjusted BMD was -0.62 +/- 0.5 SD for patients and 0.81 +/- 0.09 SD for controls (P = 0.04). After adjustment, four patients and none of the controls presented BMD < -1 SD (P = 0.01). Osteocalcin, CTX, calcium, and phosphorus blood levels were not significantly different between patients and controls. Celiac autoimmunity is associated with reduced bone mineralization in type 1 diabetic patients. The pathophysiological mechanisms and clinical relevance of this finding remain to be further investigated.

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“…Fickling [19] analyzed previous fractures in patients admitted to a digestive unit and found an increased risk of 7% in celiac patients with a higher mean age and a body mass index (BMI) within normal limits. Moreno et al [20] studied all fractures (osteoporotic and nonosteoporotic), with an increase of 7% although the quality of the study was reduced due to the discordance between cases (14) and controls (296). A case-control study of post-menopausal women aged older 50 years included 383 celiac patients and 445 controls and found an increased risk of fractures in celiac patients (OR 1.51;95% CI 1.13-2.02) [21].…”

Section: Osteoporosis and Celiac Diseasementioning

confidence: 99%