1
|
Gorini F, Tonacci A. Vitamin D: An Essential Nutrient in the Dual Relationship between Autoimmune Thyroid Diseases and Celiac Disease-A Comprehensive Review. Nutrients 2024; 16:1762. [PMID: 38892695 PMCID: PMC11174782 DOI: 10.3390/nu16111762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Autoimmune thyroid diseases (AITD) are among the most frequent autoimmune disorders, with a multifactorial etiology in which both genetic and environmental determinants are probably involved. Celiac disease (CeD) also represents a public concern, given its increasing prevalence due to the recent improvement of screening programs, leading to the detection of silent subtypes. The two conditions may be closely associated due to common risk factors, including genetic setting, changes in the composition and diversity of the gut microbiota, and deficiency of nutrients like vitamin D. This comprehensive review discussed the current evidence on the pivotal role of vitamin D in modulating both gut microbiota dysbiosis and immune system dysfunction, shedding light on the possible relevance of an adequate intake of this nutrient in the primary prevention of AITD and CeD. While future technology-based strategies for proper vitamin D supplementation could be attractive in the context of personalized medicine, several issues remain to be defined, including standardized assays for vitamin D determination, timely recommendations on vitamin D intake for immune system functioning, and longitudinal studies and randomized controlled trials to definitely establish a causal relationship between serum vitamin D levels and the onset of AITD and CeD.
Collapse
Affiliation(s)
- Francesca Gorini
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy;
| | | |
Collapse
|
2
|
Zhou C, Yang L, Liu C, Ma H, Yang F, Chen L. Associations between special diet and incidence risk of osteoporosis: a Mendelian randomization study. Front Public Health 2024; 12:1364735. [PMID: 38873319 PMCID: PMC11171419 DOI: 10.3389/fpubh.2024.1364735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Osteoporosis is a prevalent challenge in clinical orthopedics, affecting a significant percentage of individuals aged 50 and above. The goal of this study was to comprehensively understand the relationships between a specialized dietary regimen and the risk of developing osteoporosis. Methods This study employed extensive genome-wide association study (GWAS) summary statistics derived from the UK Biobank. It encompassed 8 kinds of special diets and 7 datasets pertaining to osteoporosis and associated symptoms. The principal analytical approach employed was the inverse-variance weighted method. Additionally, sensitivity analysis was employed to elucidate the diverse multiplicity patterns observed in the final model. Results Our results showed that there is significant evidence that a gluten-free diet is associated with osteoporosis [odds ratio (OR): 1.080, 95% confidence interval (CI): 1.048-1.112, p = 4.23E-07)]. Furthermore, there exists a suggestive link between the three distinct dietary approaches and osteoporosis [(OR: 0.949, 95%CI: 0.929-0.970, p = 3.00E-06) for comprehensive consumption; (OR: 1.053, 95%CI: 1.018-1.089, p = 2.23E-03) for abstaining from wheat consumption; (OR: 1.036, 95%CI: 1.005-1.068, p = 1.97E-02) for abstaining from sugar consumption]. No additional correlation between the special dietary regimens and osteoporosis has been observed. Conclusion Our research has uncovered a notable correlation between a gluten-free diet and the occurrence of osteoporosis. Furthermore, it exerts a promoting influence on the onset of osteoporosis, which stands in direct contradiction to the therapeutic principles for Celiac Disease's complications. As such, a novel association among these three elements is postulated.
Collapse
Affiliation(s)
- Changwen Zhou
- The First Clinical Medical Research Institute, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Lixue Yang
- The First Clinical Medical Research Institute, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
- Affiliation Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Ce Liu
- The First Clinical Medical Research Institute, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Hongzhong Ma
- The First Clinical Medical Research Institute, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Feng Yang
- The First Clinical Medical Research Institute, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
- Affiliation Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Liheng Chen
- Affiliation Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| |
Collapse
|
3
|
Skoracka K, Hryhorowicz S, Tovoli F, Raiteri A, Rychter AM, Słomski R, Dobrowolska A, Granito A, Krela-Kaźmierczak I. Genetic, Immunological, Dietary, Gut Microbiota, and Environmental Determinants of Osteoporosis in the Course of Celiac Disease: Which Factor Plays the First Violin in This Orchestra? Calcif Tissue Int 2024; 114:98-109. [PMID: 38049681 PMCID: PMC10803478 DOI: 10.1007/s00223-023-01155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/24/2023] [Indexed: 12/06/2023]
Abstract
Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals. The worldwide prevalence of CD is estimated to be 0.7-1.4% of the general population. Etiopathology of this disease is multifactorial, with genetic determinants being a major contributing player to CD susceptibility. Its manifestation embraces different organs, including the musculoskeletal apparat. Patients with CD have increased risk of bone disorders. According to data, bone disorders - osteopenia and osteoporosis - can affect up to 70% of patients with CD at diagnosis, and it decreases after the initiation of a gluten-free diet. Gluten consumption in patients with CD triggers an inflammatory reaction followed by tissue damage, and both; local and systemic inflammation can increase the risk of bone mass deterioration. Other theory assumes shortages of vitamin D and an impaired calcium absorption mechanism leading to secondary hyperparathyroidism. Taking into account the increasing prevalence of CD and osteoporosis, we broadly discuss genetic, immunological, dietary, gut microbiota, and environmental factors that could increase the risk of osteoporosis in CD. Furthermore, we discuss lifestyle and pharmacological preventing and treatment measures.
Collapse
Affiliation(s)
- Kinga Skoracka
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewski Street, 60-355, Poznan, Poland.
- Doctoral School, Poznan University of Medical Sciences, Fredry St. 10, 61-701, Poznan, Poland.
| | - Szymon Hryhorowicz
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479, Poznan, Poland.
| | - Francesco Tovoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Raiteri
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anna Maria Rychter
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewski Street, 60-355, Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, Fredry St. 10, 61-701, Poznan, Poland
| | - Ryszard Słomski
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479, Poznan, Poland
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewski Street, 60-355, Poznan, Poland
| | - Alessandro Granito
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Iwona Krela-Kaźmierczak
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewski Street, 60-355, Poznan, Poland
| |
Collapse
|
4
|
Xin C, Imanifard R, Jarahzadeh M, Rohani P, Velu P, Sohouli MH. Impact of Gluten-free Diet on Anthropometric Indicators in Individuals With and Without Celiac Disease: A Systematic Review and Meta-analysis. Clin Ther 2023; 45:e243-e251. [PMID: 37903705 DOI: 10.1016/j.clinthera.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE Previous studies have found that a gluten-free diet (GFD) may have improve obesity-related factors. For this reason, we conducted a systematic review and meta-analysis to investigate the effect of a GFD on anthropometric indicators. METHODS We performed a systematic search in databases from inception until July 12, 2022. We included all relevant articles that evaluate efficacy of a GFD on anthropometric indicators in patients with and without celiac disease (CD). Random-effects models were applied to combine the data. The main outcomes were then analyzed using weight mean differences (WMDs) and 95% CIs. FINDINGS A total of 27 articles met the eligible criteria and were included. Pooled results from the random-effects model indicated that the GFD has no significant effect on any of the factors of anthropometry, including weight (WMD, 1.20 kg; 95% CI, -1.16 to 3.55 kg; P = 0.319), body mass index (WMD, 0.70 kg/m2; 95% CI, -0.45 to 1.84 kg/m2; P = 0.233), waist circumference (WMD, 0.92 cm; 95% CI, -1.34 to 3.17 cm; P = 0.497), and body fat (WMD, 1.02%; 95% CI, -0.38% to 2.42%; P = 0.153). The subgroup results indicated that after implementation of a GFD significant increased weight and body fat occurred in patients with compared with without CD. In addition, the effect of this diet on the increase of BMI and body fat in the intervention of more than 48 weeks was significantly higher. IMPLICATIONS The results of the present study indicate that a GFD can have a significant and beneficial effect on weight and body fat in patients with CD.
Collapse
Affiliation(s)
- Chenleng Xin
- Hunan Provincial People's Hospital Xingsha Branch, Changsha, 410008, China
| | | | | | - Pejman Rohani
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Periyannan Velu
- Galileovasan Offshore and Research and Development Pvt Ltd, Nagapattinam, Tamil Nadu, India
| | - Mohammad Hassan Sohouli
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
5
|
The Effect of a Gluten-Free Diet on Vitamin D Metabolism in Celiac Disease: The State of the Art. Metabolites 2023; 13:metabo13010074. [PMID: 36676999 PMCID: PMC9861273 DOI: 10.3390/metabo13010074] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Celiac disease is a chronic autoimmune disorder involving the small intestine, characterized by villous atrophy, crypt hyperplasia and an increase in intraepithelial lymphocytes. Due to both calcium malabsorption and immune activation, a high prevalence of bone mass derangement is evident in this condition, regardless of the presence of overt malabsorption. Alterations of mineral metabolism are also frequently described, and in this review, the modifications of serum levels of vitamin D are analyzed, according to the available literature on this topic. In untreated patients, secondary hyperparathyroidism is responsible for the hyperconversion of 25-vitamin D into 1,25-vitamin D making mandatory the determination of serum levels of both vitamin metabolites to avoid a wrong diagnosis of vitamin D deficit. A gluten-free diet allows for a normalization of bone and mineral metabolism, reverting these abnormalities and raising some doubts on the need for vitamin supplementation in all the patients. Data available do not support this wide indication, and a complete evaluation of bone and mineral metabolism should be performed to select patients who need this therapeutic approach.
Collapse
|
6
|
Al-Toma A, Herman A, Lems WF, Mulder CJJ. The Dietary and Non-Dietary Management of Osteoporosis in Adult-Onset Celiac Disease: Current Status and Practical Guidance. Nutrients 2022; 14:4554. [PMID: 36364816 PMCID: PMC9654202 DOI: 10.3390/nu14214554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 12/08/2023] Open
Abstract
Impaired bone mineral density (BMD) is a frequent complication of adult-onset celiac disease (CeD). This is usually due to malabsorption of nutrients, changes in bone metabolism in association with inflammation, and to a lesser extent, decreased overall physical health and mobility. This review aims to highlight the current status concerning surveillance, prevention, and treatment strategies for bone disease in CeD. A practical guidance on these matters is suggested. The available published research on the prevention and treatment of decreased BMD in relation to CeD is scarce. In general, publications were based on expert opinions or extrapolation from studies on postmenopausal women or inflammatory bowel disease. Optimal dietary treatment and an adequate supply of calcium and vitamin D are the cornerstones for the reduction in fracture risk in patients with CeD. In adults with low BMD or fragility fractures, CeD needs to be considered and specifically approached. When osteoporosis is documented, start treatment with an antiresorptive agent; these agents are proven to result in a long-term reduction in fracture risk in high-risk individuals. However, there are some important differences between the management of male and female patients, particularly premenopausal women, that need to be addressed. In patients with persisting diarrhea and malabsorption, parenteral medications may be preferable. Future research specifically focusing on celiac disease and the associated disorders in bone mineralization is mandatory to provide evidence-based recommendations in this field.
Collapse
Affiliation(s)
- Abdulbaqi Al-Toma
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Amin Herman
- Department of Rheumatology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Willem F. Lems
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Location Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Chris J. J. Mulder
- Department of Gastroenterology, Amsterdam UMC, Location Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
7
|
Sobh MM, Abdalbary M, Elnagar S, Nagy E, Elshabrawy N, Abdelsalam M, Asadipooya K, El-Husseini A. Secondary Osteoporosis and Metabolic Bone Diseases. J Clin Med 2022; 11:jcm11092382. [PMID: 35566509 PMCID: PMC9102221 DOI: 10.3390/jcm11092382] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023] Open
Abstract
Fragility fracture is a worldwide problem and a main cause of disability and impaired quality of life. It is primarily caused by osteoporosis, characterized by impaired bone quantity and or quality. Proper diagnosis of osteoporosis is essential for prevention of fragility fractures. Osteoporosis can be primary in postmenopausal women because of estrogen deficiency. Secondary forms of osteoporosis are not uncommon in both men and women. Most systemic illnesses and organ dysfunction can lead to osteoporosis. The kidney plays a crucial role in maintaining physiological bone homeostasis by controlling minerals, electrolytes, acid-base, vitamin D and parathyroid function. Chronic kidney disease with its uremic milieu disturbs this balance, leading to renal osteodystrophy. Diabetes mellitus represents the most common secondary cause of osteoporosis. Thyroid and parathyroid disorders can dysregulate the osteoblast/osteoclast functions. Gastrointestinal disorders, malnutrition and malabsorption can result in mineral and vitamin D deficiencies and bone loss. Patients with chronic liver disease have a higher risk of fracture due to hepatic osteodystrophy. Proinflammatory cytokines in infectious, autoimmune, and hematological disorders can stimulate osteoclastogenesis, leading to osteoporosis. Moreover, drug-induced osteoporosis is not uncommon. In this review, we focus on causes, pathogenesis, and management of secondary osteoporosis.
Collapse
Affiliation(s)
- Mahmoud M. Sobh
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt; (M.M.S.); (M.A.); (S.E.); (E.N.); (N.E.); (M.A.)
| | - Mohamed Abdalbary
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt; (M.M.S.); (M.A.); (S.E.); (E.N.); (N.E.); (M.A.)
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY 40506, USA
| | - Sherouk Elnagar
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt; (M.M.S.); (M.A.); (S.E.); (E.N.); (N.E.); (M.A.)
| | - Eman Nagy
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt; (M.M.S.); (M.A.); (S.E.); (E.N.); (N.E.); (M.A.)
| | - Nehal Elshabrawy
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt; (M.M.S.); (M.A.); (S.E.); (E.N.); (N.E.); (M.A.)
| | - Mostafa Abdelsalam
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt; (M.M.S.); (M.A.); (S.E.); (E.N.); (N.E.); (M.A.)
| | - Kamyar Asadipooya
- Division of Endocrinology, University of Kentucky, Lexington, KY 40506, USA;
| | - Amr El-Husseini
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY 40506, USA
- Correspondence: ; Tel.: +1-859-218-0934
| |
Collapse
|
8
|
Schiepatti A, Maimaris S, Nicolardi ML, Alimenti E, Vernero M, Costetti M, Costa S, Biagi F. Determinants and Trends of Adherence to a Gluten-Free Diet in Adult Celiac Patients on a Long-term Follow-up (2000-2020). Clin Gastroenterol Hepatol 2022; 20:e741-e749. [PMID: 33338656 DOI: 10.1016/j.cgh.2020.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Data on factors governing long-term adherence to a gluten-free diet (GFD) in celiac disease (CD) are scarce. We aimed to determine trends and clinical predictors of long-term GFD adherence in adult CD. METHODS Initial and long-term (>3 years) GFD adherence, clinical characteristics at baseline and follow-up were collected retrospectively from celiac patients followed-up over 20 years (2000-2020). Predictors of long-term GFD adherence at diagnosis, and follow-up were evaluated by multivariate logistic regression. RESULTS 248 patients (37 ± 12 years, 186F, median time on a GFD 90 months) were included. Twenty-five (10.1%) had only short-term follow-up (<3 years) while 223 (89.9%) had initial and long-term dietary assessment. 187/223 (83.9%) patients were initially adherent and 36/223 (16.1%) were not. 17/36 (47.2%) patients initially not adherent become adherent, while only 4/187 (2.1%) initially adherent patients became not adherent. In the long-term, 200/223 (89.7%) were adherent and 21/223 (9.4%) patients were not. Adherence improved more frequently than worsened (OR, 39.5; 95% CI, 11.4-178.5; P < .01). Classical symptoms (diarrhea, weight loss) at diagnosis of CD predicted stricter long-term GFD adherence (OR, 3.27; 95% CI, 1.21-8.81; P = .02), while anemia (OR, 0.31; 95% CI, 0.12-0.82; P = .02) and dermatitis herpetiformis (OR, 0.23; 95% CI, 0.06-0.91; P = .04) predicted poorer long-term adherence. At follow-up, initial GFD adherence (OR, 42.70; 95% CI, 10.70-171.00; P = .04) was the major determinant of long-term GFD adherence. CONCLUSIONS GFD adherence changes over time in <10% of patients, generally improving when it does. Major determinants of long-term GFD adherence are classical symptoms at diagnosis and initial adherence to a GFD. Patients with anemia or dermatitis herpetiformis at diagnosis require stricter dietetic input.
Collapse
Affiliation(s)
- Annalisa Schiepatti
- Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, Pavia, Italy.
| | - Stiliano Maimaris
- Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, Pavia, Italy
| | - Maria Luisa Nicolardi
- Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, Pavia, Italy
| | - Eleonora Alimenti
- Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, Pavia, Italy
| | - Marta Vernero
- Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, Pavia, Italy
| | - Martina Costetti
- Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, Pavia, Italy
| | - Stefania Costa
- Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, Pavia, Italy
| | - Federico Biagi
- Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, Pavia, Italy
| |
Collapse
|
9
|
Davie M. Appendicular Tissue at Diagnosis and at Follow Up in Women Over 50y With Coeliac Disease. J Clin Densitom 2022; 25:105-112. [PMID: 34456142 DOI: 10.1016/j.jocd.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
Coeliac disease (CD) affects lean, fat and bone composition in the limbs. Many studies compare CD patients with controls who are inappropriate in relation to weight, sex, and age. Thus, although CD patients may have deficiency of appendicular lean and bone, whether this applies when these variables are controlled is uncertain. Following diagnosis, it also remains uncertain whether lean and bone increase or decline. Forty-four female CD patients aged 50-79 yr at diagnosis were age and weight matched with 44 healthy controls. Fifteen CD patients were followed up after 7.5 ± 2.7 yr. Body composition and spine and hip Bone Mineral Content (BMC) were measured using DXA. Changes after 7.5 yr were compared with initial data and with data corrected for expected losses of lean and bone. At diagnosis BMC was low in both upper and lower limbs (p < 0.0001), lean was low in the upper limb (p < 0.03) and fat content was similar. BMC z scores were lower in the lower limbs than in axial sites (p< 0.02). At follow up lean when corrected for expected loss had not declined; only fat increased. BMC was unchanged but all patients had received bone active agents. If the expected decline in BMC were accounted for, BMC was greater than expected in both upper and lower limbs (p < 0.004). Appendicular Lean mass is not low in CD and does not change on treatment. BMC at diagnosis is lowest at the lower limb and may be worth measuring in women of this age to alert to the possibility of CD. BMC does not decline after treatment. If allowance is made for expected bone loss BMC increases slightly, but it would take about 15 yr to achieve the age related mean.
Collapse
Affiliation(s)
- Michael Davie
- Charles Salt Centre for Human metabolism, Robert Jones and Agnes Hunt Hospital, Oswestry, UK.
| |
Collapse
|
10
|
Long-Term Adherence to a Gluten-Free Diet and Quality of Life of Celiac Patients After Transition to an Adult Referral Center. Dig Dis Sci 2022; 67:3955-3963. [PMID: 34524598 PMCID: PMC9287197 DOI: 10.1007/s10620-021-07231-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/16/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Modalities for the transition to adult care of celiac patients diagnosed during childhood/adolescence and their impact on long-term adherence to a gluten-free diet (GFD-A), quality of life (QOL) and maintenance of follow-up in adulthood are unknown. AIMS To evaluate whether timing of transition affects long-term GFD-A, QOL, and continuity of follow-up in adulthood and to identify predictors of long-term GFD-A. METHODS Clinical and demographic data about pediatric care and adult follow-up at our center were retrospectively collected from clinical notes of celiac patients diagnosed during childhood/adolescence and then referred to our tertiary center. QOL and adult long-term GFD-A were prospectively evaluated with validated questionnaires. These parameters were studied by means of univariate and multivariate statistical analysis. RESULTS 183 patients (130F, mean age at diagnosis 7.6 ± 5.8 years) were enrolled. Median age at transition to adult care was 20 years (IQR 17-25). There was no relationship between age at transition to adult care, long-term GFD-A, QOL, and continuity of follow-up. GFD-A tended to improve overall from pediatric care to adult referral (OR 2.92, 95% CI 1.13-7.87, p = 0.02) and also throughout adult follow-up (OR 9.0, 95% CI 4.2-19.7, p < 0.01). On multivariable logistic regression analysis, classical symptoms at diagnosis of celiac disease (p = 0.02) and good GFD-A at adult referral (p < 0.01) predicted good long-term GFD-A, while being lost to follow-up predicted poorer long-term GFD-A (p = 0.02). CONCLUSIONS Clinical characteristics can guide development of personalized strategies for implementing long-term GFD-A and ensure maintenance of regular follow-up in celiac patients diagnosed in childhood/adolescence and transitioning to adult care.
Collapse
|
11
|
Görög A, Antiga E, Caproni M, Cianchini G, De D, Dmochowski M, Dolinsek J, Drenovska K, Feliciani C, Hervonen K, Lakos Jukic I, Kinyó Á, Koltai T, Korponay-Szabó I, Marzano AV, Patsatsi A, Rose C, Salmi T, Schmidt E, Setterfield J, Shahid M, Sitaru C, Uzun S, Valitutti F, Vassileva S, Yayli S, Sárdy M. S2k guidelines (consensus statement) for diagnosis and therapy of dermatitis herpetiformis initiated by the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol 2021; 35:1251-1277. [PMID: 34004067 DOI: 10.1111/jdv.17183] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/14/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Dermatitis herpetiformis (DH) is a chronic, pruritic, gluten-induced skin disorder characterized by subepidermal granular IgA deposition and a variable degree of enteropathy identical to that seen in coeliac disease. So far, there has been no European consensus about the management of DH. METHODS The guidelines were created by small subgroups of a guideline committee consisting of 26 specialists from various medical fields and one patients' representative. The members of the committee then discussed the guidelines and voted for the final version at two consensus meetings. The guidelines were developed under the support of the European Academy of Dermatology and Venereology (EADV) and in collaboration with the European Dermatology Forum (EDF). RESULTS The guidelines summarize evidence-based and expert-based recommendations (S2 level) for the management of DH (see Appendix). CONCLUSION These guidelines will improve the quality of management of DH and support dermatologists in their diagnostic and therapeutic decisions.
Collapse
Affiliation(s)
- A Görög
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - E Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - M Caproni
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, USL Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - G Cianchini
- Department of Dermatology, Cristo Re Hospital, Rome, Italy
| | - D De
- Department of Dermatology, Postgraduate Institute of Medical Education Research, Chandigarh, India
| | - M Dmochowski
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznań, Poland
| | - J Dolinsek
- Gastroenterology Unit, Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia.,Medical Faculty, University of Maribor, Maribor, Slovenia
| | - K Drenovska
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - C Feliciani
- Dermatology Unit Azienda Ospedaliero - Universitaria, Università di Parma, Parma, Italy
| | - K Hervonen
- Coeliac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - I Lakos Jukic
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Á Kinyó
- Department of Dermatology, Venereology and Oncodermatology, University of Pécs Medical School, Pécs, Hungary
| | - T Koltai
- Association of European Coeliac Societies, Brussels, Belgium.,Hungarian Coeliac Society, Budapest, Hungary
| | - I Korponay-Szabó
- Coeliac Disease Centre, Heim Pál National Paediatric Institute, Budapest, Hungary.,Faculty of Medicine, Institute of Paediatrics, University of Debrecen, Debrecen, Hungary
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - A Patsatsi
- Autoimmune Bullous Diseases Unit, 2nd Dermatology Department, Aristotle University School of Medicine, Thessaloniki, Greece
| | - C Rose
- Dermatopathology Laboratory, Lübeck, Germany.,German Coeliac Disease Society e. V., Stuttgart, Germany
| | - T Salmi
- Coeliac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - J Setterfield
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Host Microbiome Interactions, Faculty of Dentistry Oral & Craniofacial Sciences, King's College London, London, UK
| | - M Shahid
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - C Sitaru
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,BIOSS Centre for Biological Signalling, University of Freiburg, Freiburg, Germany
| | - S Uzun
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - F Valitutti
- Pediatric Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - S Vassileva
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - S Yayli
- Department of Dermatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - M Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary.,Department of Dermatology and Allergy, University Hospital of LMU, Munich, Germany
| |
Collapse
|
12
|
Nutritional Status in Spanish Adults with Celiac Disease Following a Long-Term Gluten-Free Diet Is Similar to Non-Celiac. Nutrients 2021; 13:nu13051626. [PMID: 34066195 PMCID: PMC8151936 DOI: 10.3390/nu13051626] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
The only available treatment for celiac disease is life-long gluten exclusion. We conducted a cross-sectional age- and gender-matched study in 64 celiac adults on a long-term (>1 year) gluten-free diet and 74 non-celiac volunteers from Spain, using dietary, anthropometric, and biochemical parameters, as well as assessing bone mineral density and physical activity. Celiac adults had deficient intake (below 2/3 of the recommended intake) for folates, vitamin E, and iodine and low intake of calcium (below 80% of the recommended intake). Iron intake was also below 2/3 of the recommended intake in celiac women. Vitamin D intake was extremely low, and 34% of celiac patients had moderately deficient plasma levels. According to bone mineral density, celiac women may be more prone to osteopenia and osteoporosis. However, we found a perfectly analogous nutritional status scenario in celiac as compared to healthy volunteers, with the dietary deviations found being similar to those of the Spanish population, i.e., both groups followed a high-lipid, high-protein, and low-carbohydrate diet. Values for biochemical parameters were found within the reference ranges. Celiac disease had no influence on body weight, but body fat in celiac patients tended to be higher. According to our results, vitamin D, calcium, folates, vitamin E, iodine, and iron nutritional status should be specifically assessed and monitored in the celiac population.
Collapse
|
13
|
de Bruin IJA, Vranken L, Wyers CE, van der Velde RY, Trienekens TAM, Kaarsemaker S, Janzing HMJ, Wolters FL, Wouda S, Geusens PPMM, van den Bergh JPW. The Prevalence of Celiac Disease in a Fracture Liaison Service Population. Calcif Tissue Int 2020; 107:327-334. [PMID: 32725291 PMCID: PMC7497300 DOI: 10.1007/s00223-020-00725-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
Celiac disease (CD) is a known risk factor for osteoporosis and fractures. The prevalence of CD in patients with a recent fracture is unknown. We therefore systematically screened patients at a fracture liaison service (FLS) to study the prevalence of CD. Patients with a recent fracture aged ≥ 50 years were invited to VieCuri Medical Center's FLS. In FLS attendees, bone mineral density (BMD) and laboratory evaluation for metabolic bone disorders and serological screening for CD was systematically evaluated. If serologic testing for CD was positive, duodenal biopsies were performed to confirm the diagnosis CD. Data were collected in 1042 consecutive FLS attendees. Median age was 66 years (Interquartile range (IQR) 15), 27.6% had a major and 6.9% a hip fracture, 26.4% had osteoporosis and 50.8% osteopenia. Prevalent vertebral fractures were found in 29.1%. CD was already diagnosed in two patients (0.19%), one still had a positive serology. Three other patients (0.29%) had a positive serology for CD (one with gastro-intestinal complaints). In two of them, CD was confirmed by duodenal histology (0.19%) and one refused further evaluation. The prevalence of biopsy-proven CD was therefore 0.38% (4/1042) of which 0.19% (2/1042) was newly diagnosed. The prevalence of CD in patients with a recent fracture at the FLS was 0.38% and within the range of reported prevalences in the Western-European population (0.33-1.5%). Newly diagnosed CD was only found in 0.19%. Therefore, standard screening for CD in FLS patients is not recommended.
Collapse
Affiliation(s)
- Irma J A de Bruin
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Lisanne Vranken
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Robert Y van der Velde
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Thera A M Trienekens
- Department of Medical Microbiology, VieCuri Medical Center, Venlo, The Netherlands
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | | | - Frank L Wolters
- Department of Gastro-Enterology, VieCuri Medical Center, Venlo, The Netherlands
| | - Siep Wouda
- Department of Pathology, VieCuri Medical Center, Venlo, The Netherlands
| | - Piet P M M Geusens
- Department of Internal Medicine, Subdivision Rheumatology, CAPHRI, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands
- Biomedical Research Centre, Hasselt University, Agoralaan-gebouw D, 3590, Diepenbeek, Belgium
| | - Joop P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands.
- Biomedical Research Centre, Hasselt University, Agoralaan-gebouw D, 3590, Diepenbeek, Belgium.
| |
Collapse
|
14
|
Micic D, Rao VL, Semrad CE. Celiac Disease and Its Role in the Development of Metabolic Bone Disease. J Clin Densitom 2020; 23:190-199. [PMID: 31320223 DOI: 10.1016/j.jocd.2019.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/22/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
Celiac disease (CD) is an immune-mediated enteropathy that occurs in genetically susceptible hosts with the ingestion of gluten-containing products. Ongoing gluten consumption leads to intestinal damage, characterized by villous blunting and increased intraepithelial lymphocytes, resulting in malabsorption. Pertinent to the development of bone disease, malabsorption of calcium and vitamin D leads to secondary hyperparathyroidism and metabolic bone disease among individuals with CD. In this article, we review the pathogenesis of CD and the effects of malabsorption on bone health. Imbalances in bone resorption and formation particularly in individuals with CD and persistent disease activity ultimately lead to a state of bone loss and impaired mineralization. Initiation of a gluten-free diet is critical in the management of CD-related metabolic bone disease, demonstrating improvements in bone mineral density within the first year of dietary adherence.
Collapse
Affiliation(s)
- Dejan Micic
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA.
| | - Vijaya L Rao
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA
| | - Carol E Semrad
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA
| |
Collapse
|
15
|
Kreutz JM, Adriaanse MPM, van der Ploeg EMC, Vreugdenhil ACE. Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease. Nutrients 2020; 12:nu12020500. [PMID: 32075276 PMCID: PMC7071237 DOI: 10.3390/nu12020500] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/05/2020] [Accepted: 02/13/2020] [Indexed: 12/16/2022] Open
Abstract
Nutrient deficiencies are well recognized as secondary consequences of celiac disease (CD) and closely related to the clinical presentation of affected patients. Despite their clinical significance, consensus is lacking on the pattern and frequency of nutrient deficiencies in CD, the usefulness of their assessment at the time of diagnosis and during follow-up. This review aims to provide an overview of nutrient deficiencies among pediatric and adult CD patients at diagnosis and on a gluten-free diet (GFD), and their potential causes in CD. Secondly, we review their impact on CD management strategies including the potential of nutrient supplementation. A search of Medline, Pubmed and Embase until January 2019 was performed. Despite a high variability between the reported deficiencies, we noted that nutrient deficiencies occur frequently in children and adults with CD at diagnosis and during treatment with a GFD. Both inadequate dietary intake and/or diminished uptake due to intestinal dysfunction contribute to nutrient deficiencies. Most deficiencies can be restored with (long-term) treatment with a GFD and/or supplementation. However, some of them persist while others may become even more prominent during GFD. Our results indicate a lack of comprehensive evidence on the clinical efficacy of nutrient supplementation in CD management highlighting the need for further studies.
Collapse
Affiliation(s)
- Johanna M. Kreutz
- Department of Paediatrics and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (J.M.K.); (M.P.M.A.)
| | - Marlou P. M. Adriaanse
- Department of Paediatrics and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (J.M.K.); (M.P.M.A.)
| | | | - Anita C. E. Vreugdenhil
- Department of Paediatrics and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (J.M.K.); (M.P.M.A.)
- Correspondence: ; Tel.: +31-433875284
| |
Collapse
|
16
|
Walker MD, Williams J, Lewis SK, Bai JC, Lebwohl B, Green PHR. Measurement of Forearm Bone Density by Dual Energy X-Ray Absorptiometry Increases the Prevalence of Osteoporosis in Men With Celiac Disease. Clin Gastroenterol Hepatol 2020; 18:99-106. [PMID: 30981003 DOI: 10.1016/j.cgh.2019.03.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Guidelines advise measurement of bone mineral density (BMD) in patients with a diagnosis of celiac disease. The lumbar spine (LS) and hip sites are usually measured. Although skeletal sites rich in trabecular bone are believed to be vulnerable to osteoporosis in patients with celiac disease, most studies have not measured the cortical distal 1/3-radius. METHODS We collected data from 721 patients (mean age, 43.6 years; 68.4% female) with celiac disease who underwent 3-site dual energy x-ray absorptiometry (DXA, at a median 1.22 years after diagnosis). We assessed skeletal site- and sex-specific osteoporosis prevalence and the incremental utility of 1/3-radius measurement by DXA. RESULTS Mean T- and Z-scores were normal in patients, but 43.3% had osteopenia and 19.6% had osteoporosis. Osteoporosis was found in 12.1% of patients at the LS, 5.3% of patients at the total hip, 7.6% of patients at the femoral neck, and 11.5% of patients at the 1/3-radius. A greater degree of villous atrophy at diagnosis was associated with male sex and lower T-scores at the 1/3-radius (P = .03), but not other skeletal sites. Isolated forearm osteoporosis was detected in 4.9% of patients. A higher proportion of patients with isolated forearm osteoporosis were male and had a greater weight and body mass index (all P < .01, compared to patients with osteoporosis only at other sites). Z-scores were lower at the LS and 1/3-radius and osteoporosis was more common in men than women. In men, the 1/3-radius was the most frequent site for osteoporosis. Among patients 50 years or older, isolated forearm osteoporosis was present in 10.7%. CONCLUSIONS Based on DXA analysis of patients with celiac disease, the prevalence of osteoporosis appears to be underestimated-particularly in men when BMD at the 1/3-radius is not measured. Degree of villous atrophy is associated with BMD at the 1/3-radius and nearly 5% of patients have osteoporosis limited to that site. Recommendations for osteoporosis screening in patients with celiac disease should include measurement of the distal 1/3-radius in addition to the hip and LS.
Collapse
Affiliation(s)
- Marcella D Walker
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, New York.
| | - John Williams
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Suzanne K Lewis
- Division of Gastroenterology, Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Julio C Bai
- Department of Gastroenterology, Universidad del Salvador, Buenos Aires, Argentina
| | - Benjamin Lebwohl
- Division of Gastroenterology, Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Peter H R Green
- Division of Gastroenterology, Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| |
Collapse
|
17
|
Valero C, García MJ. Bone Metabolism in Inflammatory Bowel Disease and Celiac Disease. Clin Rev Bone Miner Metab 2019. [DOI: 10.1007/s12018-019-09269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
18
|
Hære P, Høie O, Lundin KEA, Haugeberg G. No major reduction in bone mineral density after long-term treatment of patients with Celiac Disease. Eur J Intern Med 2019; 68:23-29. [PMID: 31401019 DOI: 10.1016/j.ejim.2019.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/24/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND At time of diagnosis, patients with celiac disease (CD) have been shown to have lower bone mineral density (BMD) than healthy controls. It is unclear whether adult patients with CD can regain a normal BMD after treatment with a gluten-free diet (GFD). METHODS Patients diagnosed with CD as adults, who had been treated with GFD for a minimum of two years, were examined by dual energy X-ray absorptiometry (DXA) to determine BMD at femoral neck and spine L2-4. Adherence to GFD was measured using the Celiac Disease Adherence Test (CDAT) scoring tool. RESULTS 143 CD patients underwent DXA assessment, mean age was 55.8 years and mean treatment duration was 9.3 years. 67% of the patients were women, and 51% of these were postmenopausal. The prevalence of low bone mass (Z-score ≤ -1.0) was 18.2% (95%CI: 12.7-25.3%) at femoral neck and 23.1% (95%CI: 16.9-30.6%) at spine L2-4. An increase in low bone density prevalence at spine L2-4 compared to the expected prevalence (p = 0.016) was limited to the postmenopausal women. In a multiple regression analysis, only postmenopausal status and poor adherence to GFD was independently associated with reduced bone density, this however limited to spine L2-4. CONCLUSION Our study shows a small increase in the prevalence of low bone density at lumbar spine limited to the postmenopausal women. The main finding is that the majority of the CD patients after two years of treatment with GFD had a normal bone density when adjusted for age, gender, ethnicity and weight.
Collapse
Affiliation(s)
- Petter Hære
- Sørlandet Hospital HF, Norway and Institute of Clinical Medicine, University of Oslo, Norway.
| | | | - Knut E A Lundin
- Dept of Gastroenterology, Oslo University Hospital, Rikshospitalet, Norway and K.G. Jebsen Coeliac Disease Research Center, University of Oslo,Norway
| | | |
Collapse
|
19
|
Neutrophil-to-Lymphocyte Ratio, Mediterranean Diet, and Bone Health in Coeliac Disease Patients: A Pilot Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:7384193. [PMID: 31320984 PMCID: PMC6610747 DOI: 10.1155/2019/7384193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/10/2019] [Accepted: 04/18/2019] [Indexed: 12/18/2022]
Abstract
Neutrophil-to-lymphocyte ratio (NLR) has been proposed as a bone loss index in postmenopausal women and as a marker of inflammation in coeliac patients. The aims of this work were to evaluate the effect of gluten-free diet (GFD) on NLR retrospectively and study the relationship between NLR and Mediterranean diet adherence and selected food groups (fruits, vegetables, red meat, potatoes, and unrefined and refined cereals). Adult individuals (n = 50), who had been on a strict GFD by at least 6 months, were recruited. The degree of adherence to the Mediterranean diet was calculated with two different scores: the Mediterranean Diet Score (MDS-14), assessed through the validated 14-item questionnaire of the PREDIMED study, and the MEDScore (Score-55) proposed by Panagiotakos. The latter includes the consumption of unrefined cereals (UC). High percentages of osteopenia and osteoporosis were found within the recruited subjects, who furnished the reports of bone mineral density (BMD), in particular in postmenopausal (Post-M) women. Recent NLR was higher in subjects with osteoporosis compared to osteopenia and normal BMD. However, retrospective analysis showed both increase and decrease in NLR after GFD, with no significant differences between Marsh grade, anemia, and BMD status. Moreover, premenopausal previous pregnancy (Pre-MPP) and Post-M had higher NLR at diagnosis compared to Men and premenopausal (Pre-M), but higher differences were observed in recent NLR between Pre-MPP and Men only. Chocolate consumption was associated with lower recent NLR, whereas the latter was correlated with Score-55, but not with MDS-14. Moreover, refined cereal consumption was correlated with recent NLR. Although large prospective studies are needed in order to clarify the relationship between UC and NLR in coeliac patients, in this pilot study, we have investigated for the first time the relationship between NLR, dietary habit, and osteoporosis in coeliac disease.
Collapse
|
20
|
Hjelle AM, Apalset E, Mielnik P, Nilsen RM, Lundin KEA, Tell GS. Positive IgA against transglutaminase 2 in patients with distal radius and ankle fractures compared to community-based controls. Scand J Gastroenterol 2019; 53:1212-1216. [PMID: 30265163 DOI: 10.1080/00365521.2018.1509122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with celiac disease (CD), including adults with subclinical disease, have low bone mineral density (BMD), deteriorated bone microarchitecture and meta-analysis show an increased risk of fracture. Immunoglobulin A (IgA) against transglutaminase 2 (IgA TG2) is a highly reliable marker to detect CD. MAIN OBJECTIVE To explore the prevalence of positive IgA TG2 and CD in patients with distal radius and ankle fracture compared to community-based controls. METHODS Four hundred patients aged 40 years or above with distal fractures were included in a case-control study. About 197 controls were identified from the National Population Registry, those included had never suffered a fracture. BMD was measured, and comorbidities, medications, physical activity, smoking habits, body mass index (BMI) and nutritional factors were registered. Blood analysis to detect common causes of secondary osteoporosis was performed. RESULTS About 2.5% of the fracture patients had positive IgA TG2, compared to 1% in the control group. The odds ratio, adjusted for sex and age, of having positive IgA TG2 was 2.50 (95% CI 0.54-11.56). CONCLUSIONS There were no significantly increased odds of CD in adult patients with fractures compared to controls; however, results imply that positive IgA TG2 is more prevalent in fracture patients than in controls. This study indicates that universal screening for CD in fracture patients is not warranted, but supports current clinical practice in Norway to suspect and investigate for CD in patients with fracture, osteoporosis and other risk factors for CD.
Collapse
Affiliation(s)
- Anja M Hjelle
- a Department of Rheumatology, Division of Medicine , District General Hospital of Førde , Førde , Norway.,b Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
| | - Ellen Apalset
- b Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway.,c Bergen group of Epidemiology and Biomarkers in Rheumatic Disease (BeABird), Department of Rheumatology , Haukeland University Hospital , Bergen , Norway
| | - Pawel Mielnik
- a Department of Rheumatology, Division of Medicine , District General Hospital of Førde , Førde , Norway
| | - Roy M Nilsen
- d Faculty of Health and Social Sciences , Western Norway University of Applied Sciences , Bergen , Norway
| | - Knut E A Lundin
- e Department of Gastroenterology , Oslo University Hospital Rikshospitalet , Oslo , Norway.,f KG Jebsen Coeliac Disease Research Centre , University of Oslo , Oslo , Norway
| | - Grethe S Tell
- b Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
| |
Collapse
|
21
|
Walker MD, Zylberberg HM, Green PHR, Katz MS. Endocrine complications of celiac disease: a case report and review of the literature. Endocr Res 2019; 44:27-45. [PMID: 30198791 DOI: 10.1080/07435800.2018.1509868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this article is to review recent literature regarding endocrine disorders related to celiac disease (CD). METHODS We describe a case report and review existing literature on the endocrine manifestations of CD. RESULTS CD is an autoimmune disorder characterized by intestinal inflammation in response to gluten. CD can cause a wide range of extra-intestinal complications, including endocrine manifestations. Metabolic bone disease including osteoporosis and osteopenia, vitamin D deficiency, secondary hyperparathyroidism and less frequently osteomalacia can be seen. In CD, fracture risk is increased by 30-40%, while risk for hip fracture is approximately doubled. The risk for other endocrine disorders, particularly autoimmune endocrinopathies, is also increased in those with CD compared to the general population. Epidemiologic data indicate the risk for hypothyroidism is 3-4 times higher among those with CD, while risk of type 1 diabetes is greater than double. Risk for primary adrenal insufficiency is a striking 11-fold higher in those with versus without CD, though the absolute risk is low. Fertility is reduced in women with CD before diagnosis by 37% while male fertility in the absence of hypogonadism does not appear to be affected. Other endocrine conditions including hyperthyroidism, ovarian failure, androgen insensitivity, impaired growth and growth hormone deficiency and autoimmune polyendocrine syndromes have also been associated with CD. CONCLUSIONS CD is associated with a wide range of endocrine manifestations.
Collapse
Affiliation(s)
- Marcella D Walker
- a Department of Medicine , Columbia University , New York , NY , USA
| | | | - Peter H R Green
- a Department of Medicine , Columbia University , New York , NY , USA
| | - Michael S Katz
- c Department of Medicine , University of Texas Health Science Center at San Antonio , San Antonio , TX , USA
| |
Collapse
|
22
|
Galli G, Lahner E, Conti L, Esposito G, Sacchi MC, Annibale B. Risk factors associated with osteoporosis in a cohort of prospectively diagnosed adult coeliac patients. United European Gastroenterol J 2018; 6:1161-1168. [PMID: 30288278 PMCID: PMC6169042 DOI: 10.1177/2050640618784340] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/29/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Up to 75% of patients with untreated coeliac disease (CD) present with osteopenia or osteoporosis. Guidelines do not express with certainty whether each patient with newly diagnosed CD should undergo a dual-energy x-ray absorptiometry (DEXA) scan. AIM The aim of this article is to evaluate the prevalence of bone mineral density (BMD) alterations at diagnosis and risk factors associated with osteoporosis. METHODS A total of 214 adult patients (median age 38 years; female = 71.5%) newly diagnosed with CD underwent DEXA. The patients were divided into three groups: patients with normal BMD, those with osteopenia and those with osteoporosis. Clinical, histological and serological features were assessed and compared among the three groups. Logistic regression including relevant independent variables was performed. RESULTS DEXA indicated that 39.7%, 42.5% and 17.8% of the CD patients had normal BMD, osteopenia and osteoporosis, respectively. Logistic regression indicated that features significantly associated with osteoporosis were male gender (OR 4.7; 95%CI 1.1 to 20.8), age ≥45 years (OR 6.5; 95% CI 1.3 to 32.2), underweight (OR 7.4; 95% CI 1.3 to 42.5) and greater histological damage (Marsh 3C; OR 5.8; 95% CI 1.4 to 24.1). CONCLUSIONS BMD alterations were found in 60.3% of newly diagnosed adult coeliac patients. Osteoporosis was significantly associated with age ≥45 years, male gender, underweight and Marsh 3C, suggesting that at CD diagnosis, a DEXA scan might be beneficial, particularly in these subgroups of patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Bruno Annibale
- Bruno Annibale, Department of Medical-surgical Sciences and Translational Medicine, Sapienza University Sant’Andrea Hospital, Via di Grottarossa 1035–1039, Rome 00189, Italy.
| |
Collapse
|
23
|
Laszkowska M, Mahadev S, Sundström J, Lebwohl B, Green PHR, Michaelsson K, Ludvigsson JF. Systematic review with meta-analysis: the prevalence of coeliac disease in patients with osteoporosis. Aliment Pharmacol Ther 2018; 48:590-597. [PMID: 29984519 DOI: 10.1111/apt.14911] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/25/2018] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Earlier studies have produced highly varying risk estimates for the prevalence of coeliac disease (CD) in osteoporosis. AIMS To investigate the prevalence of CD among individuals with osteoporosis. METHODS We conducted a systematic review of articles published in PubMed, Medline or EMBASE through May 2017 to identify studies looking at prevalence of CD in patients with osteoporosis. Search terms included "coeliac disease" combined with "fractures", "bone disease", "bone density", "densitometry", "osteoporos*", "osteomal*", "osteodys" or "dexa" or "dxa" or "skelet". Non-English papers with English-language abstracts were included. We used fixed-effects inverse variance-weighted models, and tested heterogeneity through subgroup analysis as well as through meta-regression. RESULTS We identified eight relevant studies, comprising data from 3188 individuals with osteoporosis. Of these, 59 individuals (1.9%) had CD. A weighted pooled analysis demonstrated biopsy-confirmed CD in 1.6% (95% CI = 1.1%-2.0%) of individuals with osteoporosis. The heterogeneity was moderate (I2 = 40.1%), and influenced by the underlying CD prevalence in the general population. After adding four studies (n = 814) with CD defined as positive tissue transglutaminase or endomysial antibodies, the pooled prevalence was comparable (1.6%; 95% CI = 1.2%-2.0%). CONCLUSIONS About 1 in 62 individuals with osteoporosis, or 1.6%, have biopsy-verified CD. This prevalence is comparable to that in the general population. These findings argue against routinely screening patients with osteoporosis for CD, which is contrary to current guideline recommendations. Additional studies are needed to determine the true utility of such screening programs.
Collapse
Affiliation(s)
- M Laszkowska
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - S Mahadev
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J Sundström
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - B Lebwohl
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - P H R Green
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - K Michaelsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J F Ludvigsson
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
24
|
Zingone F, Ciacci C. The value and significance of 25(OH) and 1,25(OH) vitamin D serum levels in adult coeliac patients: A review of the literature. Dig Liver Dis 2018; 50:757-760. [PMID: 29773507 DOI: 10.1016/j.dld.2018.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 12/11/2022]
Abstract
Within the wide spectrum of symptoms and alteration of systems that characterizes CeD, several studies indicate a low-level of vitamin D, therefore recent guidelines suggest its evaluation at the time of diagnosis. This review examines the data from existing studies in which vitamin D has been assessed in CeD patients. Our review indicates that most of the studies on vitamin D in adult CeD report a 25 (OH) vitamin D deficiency at diagnosis that disappears when the patient goes on a gluten-free diet, independently of any supplementation. Instead, when the calcitriol, the active 1,25 (OH) vitamin D form, was evaluated, it resulted in the normal range at the time of CeD diagnosis. A strict and lifelong gluten-free diet can help recover vitamin D level without any supplementation.
Collapse
Affiliation(s)
- Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Carolina Ciacci
- Celiac Center, AOU San Giovanni di Dio e Ruggi di Aragona, University of Salerno, Department of Medicine and Surgery, Salerno, Italy.
| |
Collapse
|
25
|
Zylberberg HM, Lebwohl B, RoyChoudhury A, Walker MD, Green PHR. Predictors of improvement in bone mineral density after celiac disease diagnosis. Endocrine 2018; 59:311-318. [PMID: 29230636 DOI: 10.1007/s12020-017-1488-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Low bone density is frequently found in patients newly diagnosed with celiac disease (CD), and improvement is variable. This study was performed to assess changes in bone mineral density (BMD) by dual x-ray absorptiometry (DXA) at the lumbar spine, hip, and distal one-third radius as well as clinical predictors of BMD changes after the diagnosis and treatment of CD. METHODS Adult CD patients who had serial DXA at the Celiac Disease Center at Columbia University Medical Center were included (N = 103). We assessed within-person changes in BMD with paired t-tests. Multiple regression was utilized to assess baseline clinical and laboratory predictors of BMD improvement after diagnosis and treatment. RESULTS The mean age of our sample was 45.6 years (±SD 15.1) and 60% were female. After a median follow-up of 21 months, lumbar spine BMD increased by 1.7 ± 5.5% (p = 0.006) after CD diagnosis. There was a similar trend at the total hip (1.6 ± 6.3%, p = 0.06), but no change at the femoral neck or distal one-third radius. Lower baseline serum calcium predicted a greater increase in lumber spine BMD (ß = -0.0470 g/cm2, p = 0.002). At the hip, higher baseline creatinine clearance (ß = 0.005, p = 0.02) was associated with greater gains in BMD. CONCLUSION BMD increases at the lumbar spine after the diagnosis of CD and greater BMD improvement is associated with lower baseline serum calcium. This suggests that those with the lowest calcium, which is likely a surrogate for the greatest malabsorption, may have the greatest potential for improvement in skeletal health after treatment of CD.
Collapse
Affiliation(s)
- Haley M Zylberberg
- Celiac Disease Center, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Benjamin Lebwohl
- Celiac Disease Center, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Arindam RoyChoudhury
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Marcella D Walker
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Peter H R Green
- Celiac Disease Center, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA.
| |
Collapse
|
26
|
Food Allergy and Intolerance. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
27
|
Paez MA, Gramelspacher AM, Sinacore J, Winterfield L, Venu M. Delay in Diagnosis of Celiac Disease in Patients Without Gastrointestinal Complaints. Am J Med 2017. [PMID: 28623177 DOI: 10.1016/j.amjmed.2017.05.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of our study is to investigate the delay in diagnosis of patients with biopsy-proven celiac disease in those who present with gastrointestinal complaints vs nongastrointestinal complaints at our tertiary care center. Celiac disease is an autoimmune disorder that affects approximately 1% of the population worldwide. Celiac disease can have variable clinical presentations; it can be characterized by predominately gastrointestinal symptoms, or it may present without any gastrointestinal symptoms. METHODS We retrospectively reviewed the charts of 687 adult patients who carried the diagnosis of celiac disease. Patients included had biopsy-proven celiac disease and were categorized based on presence or absence of gastrointestinal symptoms prior to their diagnosis. RESULTS There were 101 patients with biopsy-proven celiac disease that met inclusion criteria. Fifty-two patients presented with gastrointestinal symptoms and 49 had nongastrointestinal complaints. Results from Mann-Whitney statistical analysis showed a median delay in diagnosis of 2.3 months for the gastrointestinal symptoms group and 42 months for the nongastrointestinal group (P <.001); 43.2% of patients with nongastrointestinal symptoms had abnormal thyroid-stimulating hormone, as opposed to 15.5% in the gastrointestinal symptom group (P = .004). Of patients with nongastrointestinal symptoms, 69.4% had anemia, compared with 11.5% of the gastrointestinal symptom group (P <.001). The majority of patients in the nongastrointestinal symptom group, 68%, were noted to have abnormal bone density scans, compared with 41% in the gastrointestinal symptom group. No sex differences were noted on chi-squared analysis between the 2 groups (P = .997). CONCLUSIONS Although there is growing awareness of celiac disease, the delay in diagnosis for patients without gastrointestinal symptoms remains prolonged, with an average delay of 3.5 years.
Collapse
Affiliation(s)
- Marco A Paez
- Division of Gastroenterology, Department of Medicine, Howard College of Medicine, Washington, DC
| | | | - James Sinacore
- Department of Public Health Sciences, Loyola University Medical Center, Maywood, Ill
| | - Laura Winterfield
- Department of Dermatology, Medical University of South Carolina, Charleston
| | - Mukund Venu
- Division of Gastroenterology, Department of Medicine, Loyola University Medical Center, Maywood, Ill.
| |
Collapse
|
28
|
Duodenal histopathology and laboratory deficiencies related to bone metabolism in coeliac disease. Eur J Gastroenterol Hepatol 2017; 29:897-903. [PMID: 28452813 DOI: 10.1097/meg.0000000000000880] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Coeliac disease (CD) is a chronic immune-mediated small intestine enteropathy precipitated by gluten in genetically predisposed individuals. Adult presentation is often atypical and malabsorption of vitamins and minerals is common, with a consequent disturbance of bone metabolism. We aim to evaluate laboratory deficiencies related to bone metabolism and the relationship between severity of histological damage and degree of bone mass loss at diagnosis of CD. MATERIALS AND METHODS A retrospective cross-sectional study of 176 adult coeliac patients was carried out. All patients fulfilled the histopathological criteria for CD. Biochemical data were analysed (calcium/phosphate/alkaline-phosphatase/vitamin D/parathormone). Duodenal histology was classified according to the Marsh classification. Bone mass density (BMD) at the lumbar and femoral regions measured by dual X-ray absorptiometry. A P-value of less than 0.05 was considered significant. RESULTS No correlation was found between the presence of gastrointestinal symptoms and the Marsh histopathological stage (P>0.05). Vitamin D deficiency was most common (44.5%), whereas only 5.7% had hypocalcaemia. Calcium was lower (P<0.05) and parathormone was higher (P=0.01) in patients with Marsh III. These patients had lower lumbar T-score (P<0.05). Although low BMD occurred in all age groups, most osteoporotic patients were aged 45-49 years (81.8%). A multiple regression analysis showed that the Marsh histopathological stage could be a predictor of lower lumbar BMD (r=0.322, B=-1.146, P<0.05). CONCLUSION Laboratory deficiencies and decreased BMD could be severe and unrelated to the presence of gastrointestinal symptoms. At diagnosis, the Marsh histopathological stage could predict the occurrence of low BMD, which carries a risk of developing into osteoporosis. In coeliac patients older than 30 years, evaluation of bone biomarkers and dual X-ray absorptiometry examination should be considered.
Collapse
|
29
|
Zanchetta MB, Longobardi V, Costa F, Longarini G, Mazure RM, Moreno ML, Vázquez H, Silveira F, Niveloni S, Smecuol E, de la Paz Temprano M, Massari F, Sugai E, González A, Mauriño EC, Bogado C, Zanchetta JR, Bai JC. Impaired Bone Microarchitecture Improves After One Year On Gluten-Free Diet: A Prospective Longitudinal HRpQCT Study in Women With Celiac Disease. J Bone Miner Res 2017; 32:135-142. [PMID: 27447366 DOI: 10.1002/jbmr.2922] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 01/06/2023]
Abstract
We have recently identified a significant deterioration of bone microarchitecture in premenopausal women with newly diagnosed celiac disease (CD) using high-resolution peripheral quantitative computed tomography (HRpQCT). The aim of this work was to assess changes in bone microarchitecture after 1 year on a gluten-free diet (GFD) in a cohort of premenopausal women. We prospectively enrolled 31 consecutive females at diagnosis of CD; 26 of them were reassessed 1 year after GFD. They all underwent HRpQCT scans of distal radius and tibia, areal BMD by DXA, and biochemical tests (bone-specific parameters and CD serology) at both time points. Secondary, we compared 1-year results with those of a control group of healthy premenopausal women of similar age and BMI in order to assess whether the microarchitectural parameters of treated CD patients had reached the values expected for their age. Compared with baseline, the trabecular compartment in the distal radius and tibia improved significantly (trabecular density, trabecular/bone volume fraction [BV/TV] [p < 0.0001], and trabecular thickness [p = 0.0004]). Trabecular number remained stable in both regions. Cortical density increased only in the tibia (p = 0.0004). Cortical thickness decreased significantly in both sites (radius: p = 0.03; tibia: p = 0.05). DXA increased in all regions (lumbar spine [LS], p = 0.01; femoral neck [FN], p = 0.009; ultradistal [UD] radius, p = 0.001). Most parameters continued to be significantly lower than those of healthy controls. This prospective HRpQCT study showed that most trabecular parameters altered at CD diagnosis improved significantly by specific treatment (GFD) and calcium and vitamin D supplementation. However, there were still significant differences with a control group of women of similar age and BMI. In the prospective follow-up of this group of patients we expect to be able to assess whether bone microarchitecture attains levels expected for their age. © 2016 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- María Belén Zanchetta
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.,Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - Vanesa Longobardi
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.,Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - Florencia Costa
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Gabriela Longarini
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Roberto Martín Mazure
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - María Laura Moreno
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Horacio Vázquez
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Fernando Silveira
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina
| | - Sonia Niveloni
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Edgardo Smecuol
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - María de la Paz Temprano
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Fabio Massari
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.,Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - Emilia Sugai
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Andrea González
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Eduardo César Mauriño
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina
| | - Cesar Bogado
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.,Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - José R Zanchetta
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.,Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - Julio César Bai
- Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología "Dr. C. Bonorino Udaondo,", Buenos Aires, Argentina.,Cátedra de Gastroenterología Facultad de Medicina, Universidad del Salvador, Buenos Aires, Argentina
| |
Collapse
|
30
|
Tuna Kırsaçlıoğlu C, Kuloğlu Z, Tanca A, Küçük NÖ, Aycan Z, Öcal G, Ensari A, Kalaycı AG, Girgin N. Bone mineral density and growth in children with coeliac disease on a gluten free-diet. Turk J Med Sci 2016; 46:1816-1821. [PMID: 28081333 DOI: 10.3906/sag-1508-52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 04/06/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM To evaluate changes in growth and bone metabolism during consumption of a gluten-free diet (GFD) in children with coeliac disease (CD). MATERIALS AND METHODS Thirty-seven children with CD (mean age of 8.8 ± 4.6 years, 21 girls) were enrolled. Anthropometric measurements, bone mineral density (BMD) in lumbar 2-4 vertebrae, and serum alkaline phosphatase, calcium, and phosphorus levels at diagnosis and at follow-up were recorded. RESULTS The mean follow-up period was 3.5 ± 2.3 years. The BMD of patients was significantly lower than that of control subjects at the time of diagnosis but not after 1 year of the GFD. Incidence of low BMD with respect to z-scores for chronological age (CA) was significantly higher than z-scores for height age (HA) (P = 0.006). At the first year of GFD, BMD, BMD z-score, height-for-age z-scores, and weight-for-age z-scores were significantly increased compared with the baseline, but not after 1 year of the GFD. CONCLUSION In CD, the first year of GFD is important in weight gain, linear growth, and improvement of BMD. A considerable relation of low BMD in children with CD, with respect to z-scores for CA, may be a result of misinterpretation of low BMD due to short stature.
Collapse
Affiliation(s)
- Ceyda Tuna Kırsaçlıoğlu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Zarife Kuloğlu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aydan Tanca
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nuriye Özlem Küçük
- Department of Nuclear Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Zehra Aycan
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gönül Öcal
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Arzu Ensari
- Department of Pathology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ayhan Gazi Kalaycı
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nurten Girgin
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
31
|
Newnham ED, Shepherd SJ, Strauss BJ, Hosking P, Gibson PR. Adherence to the gluten-free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5-year longitudinal study from diagnosis. J Gastroenterol Hepatol 2016. [PMID: 26212198 DOI: 10.1111/jgh.13060] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Key aims of treatment of coeliac disease are to heal the intestinal mucosa and correct nutritional abnormalities. AIM We aim to determine prospectively the degree of success and time course of achieving those goals with a gluten-free diet. METHODS Ninety-nine patients were enrolled at diagnosis and taught the diet. The first 52 were reassessed at 1 year and 46 at 5 years, 25 being assessed at the three time points regarding dietary compliance (dietitian-assessed), coeliac serology, bone mineral density and body composition analysis by dual energy X-ray absorptiometry, and intestinal histology. RESULTS Mean age (range) was 40 (18-71) years and 48 (76%) were female. Dietary compliance was very good to excellent in all but one. Tissue transglutaminase IgA was persistently elevated in 44% at 1 year and 30% at 5 years and were poorly predictive of mucosal disease. Rates of mucosal remission (Marsh 0) and response (Marsh 0/1) were 37% and 54%, and 50% and 85% at 1 and 5 years, respectively. Fat mass increased significantly over the first year in those with normal/reduced body mass index. Lean body mass indices more slowly improved irrespective of status at diagnosis with significant improvement at 5 years. Bone mass increased only in those with osteopenia or osteoporosis, mostly in year 1. CONCLUSION Dietary compliance is associated with a high chance of healing the intestinal lesion and correction of specific body compositional abnormalities. The time course differed with body fat improving within 1 year, and correction of the mucosal lesion and improvement in lean mass and bone mass taking longer.
Collapse
Affiliation(s)
- Evan D Newnham
- Department of Gastroenterology and Hepatology, Eastern Health Clinical School
| | - Susan J Shepherd
- Department of Gastroenterology and Hepatology, Eastern Health Clinical School
| | | | | | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
32
|
Lower Limb Metaphyseal Bone Is Lost in Men with Coeliac Disease and Does Not Relate to Parathyroid Status. J Osteoporos 2016; 2016:4131794. [PMID: 27672477 PMCID: PMC5031868 DOI: 10.1155/2016/4131794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/16/2016] [Indexed: 12/30/2022] Open
Abstract
Aims. To investigate regional lower limb bone density and associations with weight, PTH, and bone breakdown in coeliac men. Methods. From whole body DXA scans bone mineral density (BMD) was measured in 28 coeliac men, in the lower limb (subdivided into 6 regions, 3 being metaphyseal (mainly trabecular) and 2 diaphyseal (mainly cortical)). BMD at femoral neck (FN) and lumbar spine L2-4, body weight, height, serum calcium, alkaline phosphatase, parathyroid hormone (PTH), and urinary calcium and NTx/Cr, a measure of bone breakdown, were also measured. Age matched healthy men provided values for BMD calculation of z and T scores and for biochemical measurements. Results. Low BMD z scores were found at metaphyseal regions in the leg (p < 0.001) and in the FN (p < 0.05). The distal metaphyseal region BMD in the leg was lower than spine or FN (p < 0.05). PTH, urinary calcium/creatinine, and urinary NTx/Cr were similar to controls. Both metaphyseal and diaphyseal BMD z scores were associated with body weight (p < 0.02), but not with either PTH or urinary NTx/Cr. Conclusions. Low BMD lower limb regions comprising mostly trabecular bone occur early in CD and in the absence of elevated PTH or increased bone resorption. Low BMD is associated with low body weight.
Collapse
|
33
|
Margulies SL, Kurian D, Elliott MS, Han Z. Vitamin D deficiency in patients with intestinal malabsorption syndromes--think in and outside the gut. J Dig Dis 2015; 16:617-33. [PMID: 26316334 DOI: 10.1111/1751-2980.12283] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/26/2015] [Accepted: 08/04/2015] [Indexed: 12/11/2022]
Abstract
There is a very high prevalence of vitamin D deficiency, which is defined by a serum level of 25-hydroxyvitamin D [25(OH)D] of lower than 20 ng/mL, in all populations of the world. Unfortunately, the prevalence of vitamin D deficiency in patients with intestinal malabsorption syndromes, including cystic fibrosis (CF), celiac disease (CD), short bowel syndrome and inflammatory bowel disease (IBD), is higher than that in the general population, indicating the presence of disease-specific causative factors. In this review, we aimed to present clinical findings to highlight the roles of insufficient exposure to sunlight and inflammation in the development of vitamin D deficiency in patients with intestinal malabsorption syndromes. Furthermore, we aimed to present experimental evidence that supported a role of vitamin D deficiency in the pathogenesis of IBD. Finally, we reviewed clinical intervention strategies aiming to normalize vitamin D status in and even to improve the conditions of patients and to discuss certain issues that needed to be addressed in future research.
Collapse
Affiliation(s)
- Samantha L Margulies
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Divya Kurian
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mark S Elliott
- Department of Biochemistry and Molecular Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Zhiyong Han
- Department of Biochemistry and Molecular Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
34
|
Grace-Farfaglia P. Bones of contention: bone mineral density recovery in celiac disease--a systematic review. Nutrients 2015; 7:3347-69. [PMID: 25961322 PMCID: PMC4446755 DOI: 10.3390/nu7053347] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/09/2015] [Accepted: 03/26/2015] [Indexed: 02/07/2023] Open
Abstract
Metabolic bone disease is a frequent co-morbidity in newly diagnosed adults with celiac disease (CD), an autoimmune disorder triggered by the ingestion of dietary gluten. This systematic review of studies looked at the efficacy of the gluten-free diet, physical activity, nutrient supplementation, and bisphosphonates for low bone density treatment. Case control and cohort designs were identified from PubMed and other academic databases (from 1996 to 2015) that observed newly diagnosed adults with CD for at least one year after diet treatment using the dual-energy x-ray absorptiometry (DXA) scan. Only 20 out of 207 studies met the inclusion criteria. Methodological quality was assessed using the Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist. Gluten-free diet adherence resulted in partial recovery of bone density by one year in all studies, and full recovery by the fifth year. No treatment differences were observed between the gluten-free diet alone and diet plus bisphosphonates in one study. For malnourished patients, supplementation with vitamin D and calcium resulted in significant improvement. Evidence for the impact of physical activity on bone density was limited. Therapeutic strategies aimed at modifying lifestyle factors throughout the lifespan should be studied.
Collapse
Affiliation(s)
- Patricia Grace-Farfaglia
- Department of Nutritional Sciences, The University of Connecticut, Waterbury, CT 06702, USA.
- Health and Wellness Promotion, Rocky Mountain University of Health Professions, Provo, UT 84606, USA.
| |
Collapse
|
35
|
Bone mineral density at diagnosis of celiac disease and after 1 year of gluten-free diet. ScientificWorldJournal 2014; 2014:173082. [PMID: 25379519 PMCID: PMC4213989 DOI: 10.1155/2014/173082] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 12/18/2022] Open
Abstract
Atypical or silent celiac disease may go undiagnosed for many years and can frequently lead to loss of bone mineral density, with evolution to osteopenia or osteoporosis. The prevalence of the latter conditions, in case of new diagnosis of celiac disease, has been evaluated in many studies but, due to the variability of epidemiologic data and patient features, the results are contradictory. The aim of this study was to evaluate bone mineral density by dual-energy X-ray absorptiometry in 175 consecutive celiac patients at time of diagnosis (169 per-protocol, 23 males, 146 females; average age 38.9 years). Dual-energy X-ray absorptiometry was repeated after 1 year of gluten-free diet in those with T-score value <−1 at diagnosis. Stratification of patients according to sex and age showed a higher prevalence of low bone mineral density in men older than 30 years and in women of all ages. A 1-year gluten-free diet led to a significant improvement in lumbar spine and femoral neck mean T-score value. We propose that dual-energy X-ray absorptiometry should be performed at diagnosis of celiac disease in all women and in male aged >30 years, taking into account each risk factor in single patients.
Collapse
|
36
|
Hjelle AM, Apalset E, Mielnik P, Bollerslev J, Lundin KEA, Tell GS. Celiac disease and risk of fracture in adults--a review. Osteoporos Int 2014; 25:1667-76. [PMID: 24691647 DOI: 10.1007/s00198-014-2683-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/11/2014] [Indexed: 12/22/2022]
Abstract
Patients with celiac disease (CD) have low bone mineral density. Evidence of increased fracture risk in these patients is conflicting, and the indication for bone mineral density screening of all adult CD patients is debated. Our aim was to review current published data on fractures in CD. Cross-sectional cohort studies and one case study were identified by searching Medline and Embase. Although the identified studies are heterogeneous and difficult to compare, the overall findings indicate a positive association between CD and risk of fracture. Adult patients with CD should be considered for bone densitometry in order to estimate fracture risk.
Collapse
Affiliation(s)
- A M Hjelle
- Department of Rheumatology, Division of Medicine, District General Hospital of Førde, PO Box 1000, 6807, Førde, Norway,
| | | | | | | | | | | |
Collapse
|
37
|
Turner KM, Clifton PM, Keogh JB. Sodium and potassium excretion are related to bone mineral density in women with coeliac disease. Clin Nutr 2014; 34:265-8. [PMID: 24792188 DOI: 10.1016/j.clnu.2014.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/03/2014] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Women with coeliac disease may have a lower bone mineral density due to the malabsorption of calcium before diagnosis. A high sodium excretion is associated with increased calcium and bone loss. Our aim was to describe the bone mineral density (BMD) and sodium excretion in women with coeliac disease. METHODS In a cross-sectional study BMD of the lumbar spine and hip was assessed by dual energy X-ray absorptiometry. Sodium, potassium and calcium excretion were measured from a 24 h urine collection. RESULTS In 33 women (51 ± 16 yr) BMD was 1.14 ± 0.19 g/cm(2) and 0.94 ± 0.14 g/cm(2) at the lumbar spine and hip respectively. Age matched Z-scores were -0.1 ± 1.2 and -0.3 ± 1.1 at lumbar spine and hip respectively. Sodium excretion was 107 ± 51 mmol/d; 14 (42%) had a sodium excretion >100 mmol Na/d (145 ± 45 mmol/d). Potassium and calcium excretion were 87 ± 25 mmol/d and 4.1 ± 2.0 mmol/d respectively. In women with Na excretion >100 mmol Na/d, Ca excretion was significantly greater than those with <100 mmol/d (4.9 ± 2.0 vs 3.4 ± 1.8, p < 0.05). Sodium excretion and BMI were positively correlated (r = 0.61, p < 0.001) as were sodium and calcium excretion (r = 0.43, p < 0.05). Sodium excretion was inversely related to femoral neck BMD (t = -2.4 p = 0.023) after adjustment for weight, age, years since diagnosis and potassium excretion. Weight, but no other variable, was a predictor of BMD at the lumbar spine (t = 2.58 p = 0.018). CONCLUSIONS Sodium excretion was inversely related and potassium excretion positively related to femoral neck density which was similar to age matched women without coeliac disease.
Collapse
Affiliation(s)
- Kirsty M Turner
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia 5000, Australia.
| | - Peter M Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia 5000, Australia.
| | - Jennifer B Keogh
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia 5000, Australia.
| |
Collapse
|
38
|
Caruso R, Pallone F, Stasi E, Romeo S, Monteleone G. Appropriate nutrient supplementation in celiac disease. Ann Med 2013; 45:522-31. [PMID: 24195595 DOI: 10.3109/07853890.2013.849383] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Reduced levels of iron, folate, vitamin B12, vitamin D, zinc, and magnesium are common in untreated celiac disease (CD) patients probably due to loss of brush border proteins and enzymes needed for the absorption of these nutrients. In the majority of patients, removal of gluten from the diet leads to histological recovery and normalization of iron, vitamin, and mineral levels. Iron deficiency anemia is the most common extra-intestinal sign of CD and usually resolves with adherence to a gluten-free diet. However, deficiencies of both folate and vitamin B12 may persist in some patients on a gluten-free diet, thus requiring vitamin supplementation to improve subjective health status. Similarly, exclusion of gluten from the diet does not always normalize bone mineral density; in these cases, supplementation of vitamin D and calcium is recommended. Resolution of mucosal inflammation may not be sufficient to abrogate magnesium deficiency. Since gluten-free cereal products have a lower magnesium content as compared with gluten-containing counterparts, a magnesium-enriched diet should be encouraged in CD patients. In this article we discuss the frequency and clinical relevance of nutrient deficiency in CD and whether and when nutrient supplementation is needed.
Collapse
Affiliation(s)
- Roberta Caruso
- Department of Systems Medicine, University of Rome 'Tor Vergata' , 00133 Rome , Italy
| | | | | | | | | |
Collapse
|
39
|
Bone mass and mineral metabolism alterations in adult celiac disease: pathophysiology and clinical approach. Nutrients 2013; 5:4786-99. [PMID: 24284619 PMCID: PMC3847761 DOI: 10.3390/nu5114786] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/13/2013] [Accepted: 11/14/2013] [Indexed: 12/24/2022] Open
Abstract
Osteoporosis affects many patients with celiac disease (CD), representing the consequence of calcium malabsorption and persistent activation of mucosal inflammation. A slight increase of fracture risk is evident in this condition, particularly in those with overt malabsorption and in postmenopausal state. The adoption of a correct gluten-free diet (GFD) improves bone derangement, but is not able to normalize bone mass in all the patients. Biomarkers effective in the prediction of bone response to gluten-free diet are not yet available and the indications of guidelines are still imperfect and debated. In this review, the pathophysiology of bone loss is correlated to clinical aspects, defining an alternative proposal of management for this condition.
Collapse
|
40
|
Kocsis D, Miheller P, Lőrinczy K, Herszényi L, Tulassay Z, Rácz K, Juhász M. Coeliac disease in a 15-year period of observation (1997 and 2011) in a Hungarian referral centre. Eur J Intern Med 2013; 24:461-7. [PMID: 23535227 DOI: 10.1016/j.ejim.2013.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/23/2013] [Accepted: 02/25/2013] [Indexed: 01/09/2023]
Abstract
AIMS The aim of this study is to evaluate the experience of a single coeliac centre over a 15-year-long study period (between November of 1997 and September of 2011). PATIENTS AND METHODS Charts of 178 patients (139 females) with coeliac disease were retrospectively evaluated. Tests performed: multiple duodenal biopsies, anti-tissue transglutaminase and anti-endomysium antibodies, body mass index calculation, osteodensitometry, evaluation of disorders associated with coeliac disease, and implementation of family screening. RESULTS Histological samples were available in 133 cases, distribution according to Marsh-Oberhuber classification: M0 in 7%, M1-M2 in 4%, M3a in 26%, M3b in 13%, and M3c in 50% of cases, respectively. Anti-tissue transglutaminase and anti-endomysium antibody tests were available in 158 cases, 132/158 showed seropositivity. Mean body mass index values were 23.05kg/m(2) for males, and 21.07kg/m(2) for females, respectively. Osteodensitometry showed normal values in 46%, osteopenia in 36%, and osteoporosis in 18% of cases, respectively. Coeliac disease associated disorders was present in 63/178 (35%) patients. Ninety coeliacs brought 197 first degree relatives for screening, with 47/197 (23%) relatives proving to have coeliac disease. Correlations between anti-tissue transglutaminase antibody titres and Marsh-Oberhuber classification, and anti-tissue transglutaminase antibody titres and bone mineral density values were found to be statistically significant (p=0.0011, and p=0.001, respectively). CONCLUSIONS Coeliac disease can become overt at any age. Female predominance is significant. Histology usually showed advanced villous atrophy. Mean body mass index values were within normal range. The high prevalence of associated disorders is also noted. The prevalence of 24% of coeliac disease among first degree relatives underlines the necessity of family screening.
Collapse
|
41
|
Evaluation and management of skeletal health in celiac disease: position statement. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 26:819-29. [PMID: 23166906 DOI: 10.1155/2012/823648] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To review the evaluation and management of skeletal health in patients with celiac disease (CD), and to make recommendations on screening, diagnosis, treatment and follow-up of low bone mineral density (BMD) in CD patients. METHODS A multidisciplinary team developed clinically relevant questions for review. An electronic search of the literature was conducted using the MEDLINE and EMBASE databases from 1996 to 2010. All original studies, reviews and guidelines, both pediatric and adult, were included. A document summarizing the results of the review and proposed recommendations was prepared and underwent multiple revisions until consensus was reached. RESULTS At diagnosis, approximately one-third of adult CD patients have osteoporosis, one-third have osteopenia and one-third have normal BMD. Children with CD have low bone mass at diagnosis. Adult and pediatric CD patients are at increased risk of fractures. DISCUSSION For adults, serum calcium, albumin, 25(OH) vitamin D3, parathyroid hormone and 24 h urine calcium testing should be performed at diagnosis; patients with 'classic' CD and those at risk for osteoporosis should undergo a dual x-ray absorptiometry scan. An abnormal baseline dual x-ray absorptiometry scan should be repeated one to two years after initiation of a gluten-free diet (GFD). For children, BMD should be assessed one year after diagnosis if GFD adherence is not strict. A GFD is the most important treatment for bone loss. Supplemental antiresorptives may be justified in those who remain at high fracture risk (eg, postmenopausal women, older men) after implementation of a GFD. CONCLUSION Current evidence does not support the screening of all CD patients for low BMD at diagnosis. Follow-up BMD assessment should be performed one to two years after initiation of a GFD.
Collapse
|
42
|
Gluten free diet adherence in coeliac disease. The role of psychological symptoms in bridging the intention–behaviour gap. Appetite 2013; 61:52-8. [DOI: 10.1016/j.appet.2012.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/01/2012] [Accepted: 11/03/2012] [Indexed: 01/13/2023]
|
43
|
Ferrari S, Bianchi ML, Eisman JA, Foldes AJ, Adami S, Wahl DA, Stepan JJ, de Vernejoul MC, Kaufman JM. Osteoporosis in young adults: pathophysiology, diagnosis, and management. Osteoporos Int 2012; 23:2735-48. [PMID: 22684497 DOI: 10.1007/s00198-012-2030-x] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 05/14/2012] [Indexed: 01/08/2023]
Abstract
Postmenopausal osteoporosis is mainly caused by increased bone remodeling resulting from estrogen deficiency. Indications for treatment are based on low areal bone mineral density (aBMD, T-score ≤ -2.5), typical fragility fractures (spine or hip), and more recently, an elevated 10-year fracture probability (by FRAX®). In contrast, there is no clear definition of osteoporosis nor intervention thresholds in younger individuals. Low aBMD in a young adult may reflect a physiologically low peak bone mass, such as in lean but otherwise healthy persons, whereas fractures commonly occur with high-impact trauma, i.e., without bone fragility. Furthermore, low aBMD associated with vitamin D deficiency may be highly prevalent in some regions of the world. Nevertheless, true osteoporosis in the young can occur, which we define as a T-score below -2.5 at spine or hip in association with a chronic disease known to affect bone metabolism. In the absence of secondary causes, the presence of fragility fractures, such as in vertebrae, may point towards genetic or idiopathic osteoporosis. In turn, treatment of the underlying condition may improve bone mass as well. In rare cases, a bone-specific treatment may be indicated, although evidence is scarce for a true benefit on fracture risk. The International Osteoporosis Foundation (IOF) convened a working group to review pathophysiology, diagnosis, and management of osteoporosis in the young, excluding children and adolescents, and provide a screening strategy including laboratory exams for a systematic approach of this condition.
Collapse
Affiliation(s)
- S Ferrari
- Division of Bone Diseases, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Rastogi A, Bhadada SK, Bhansali A, Kochhar R, Santosh R. Celiac disease: A missed cause of metabolic bone disease. Indian J Endocrinol Metab 2012; 16:780-785. [PMID: 23087864 PMCID: PMC3475904 DOI: 10.4103/2230-8210.100674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Celiac disease (CD) is a highly prevalent autoimmune disease. The symptoms of CD are varied and atypical, with many patients having no gastrointestinal symptoms. Metabolic bone disease (MBD) is a less recognized manifestation of CD associated with spectrum of musculoskeletal signs and symptoms, viz. bone pains, proximal muscle weakness, osteopenia, osteoporosis, and fracture. We here report five patients who presented with severe MBD as the only manifestation of CD. MATERIALS AND METHODS Records of 825 patients of CD diagnosed during 2002-2010 were retrospectively analyzed for clinical features, risk factors, signs, biochemical, and radiological parameters. RESULTS We were able to identify five patients (0.6%) of CD who had monosymptomatic presentation with musculoskeletal symptoms and signs in the form of bone pains, proximal myopathy, and fragility fractures without any gastrointestinal manifestation. All the five patients had severe MBD in the form of osteopenia, osteoporosis, and fragility fractures. Four of the five patients had additional risk factors such as antiepileptic drugs, chronic alcohol consumption, malnutrition, and associated vitamin D deficiency which might have contributed to the severity of MBD. CONCLUSION Severe metabolic disease as the only presentation of CD is rare. Patients show significant improvement in clinical, biochemical, and radiological parameters with gluten-free diet, calcium, and vitamin D supplementation. CD should be looked for routinely in patients presenting with unexplained MBD.
Collapse
Affiliation(s)
- Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, India
| | | | - Anil Bhansali
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | | |
Collapse
|
45
|
Juhász M, Kocsis D, Zágoni T, Miheller P, Herszényi L, Tulassay Z. [Retrospective evaluation of the ten-year experience of a single coeliac centre]. Orv Hetil 2012; 153:776-785. [PMID: 22580504 DOI: 10.1556/oh.2012.29366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
UNLABELLED Coeliac disease (gluten-sensitive enteropathy, sprue) is a chrocic disorder of the small bowel leading to malabsorption. AIMS charts of all patients with coeliac disease treated at the 2nd Department of Medicine, Semmelweis University were evaluated. PATIENTS AND METHODS The authors retrospectively analysed the results of a total of 132 patients with coeliac disease (107 females and 25 males; mean age, 37 years; median, 35 years; range, 19-78 years) attending the centre between 1999 and 2010. The authors routinely performed the following investigations in patients with suspected coeliac disease: multiple biopsies taken from the duodenum, tissue transglutaminase antibody or endomysial antibody based serology, body mass index calculation, osteodensitometry, evaluation of disorders associated with coeliac disease, family history for coeliac disease, and implementation of family-screening for coeliac disease given the agreement of the index patients. RESULTS Histological samples were available in 101 cases, and distributions of data according to the Marsh-classification were as follows: negative in 9%, M3a in 27%, M3b in 18%, and M3c in 46% of cases, respectively. Serological results were available in 117 cases. 93/117 (79%) showed seropositivity. Body mass index was calculated for 95 patients, and the mean value for males was 22.4 kg/m² (range, 17-30.3 kg/m²), whereas the mean value for females was 20.7 kg/m² (range, 15.2-30.4 kg/m²). Osteodensitometry was performed in 90 patients; 45 patients (50%) proved normal, 31 (34%) had osteopenia, and 15 (26%) had osteoporosis. Coeliac disease associated disorders were present in 45/132 patients (34%; 6 males). Associated disorders were as follows: 15 dermatitis herpetiformis Duhring, 15 thyroid diseases (5 hypo- and 10 hyperthyroidism), 6 Crohn's disease, 3 selective IgA-deficiency, 2 endometrioses, 1 systemic lupus erythematosus, 1 myasthenia gravis, and 1 type-1 diabetes mellitus. Sixty-four of the 132 index patients brought 133 first-degree relatives for family screening (serology), where 26/133 (19.5%; 17 females) first-degree relatives proved to suffer from coeliac disease. CONCLUSIONS The age distribution of this cohort demonstrates that coeliac disease can present at any age. Similarly to those of other coeliac disease centres, female predominance is significant. Histology usually showed advanced villous atrophy. Serological results were usually in conjunction with the histological results and proved to be useful for monitoring dietary compliance and for accomplishing family screening. The mean body mass index values were in the normal range confirming that adult patients with coeliac disease are usually not malnourished. The 20% prevalence of coeliac disease among first-degree relatives underlines the necessity of family screening.
Collapse
Affiliation(s)
- Márk Juhász
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi.
| | | | | | | | | | | |
Collapse
|
46
|
Passananti V, Santonicola A, Bucci C, Andreozzi P, Ranaudo A, Di Giacomo DV, Ciacci C. Bone mass in women with celiac disease: role of exercise and gluten-free diet. Dig Liver Dis 2012; 44:379-83. [PMID: 22277809 DOI: 10.1016/j.dld.2011.12.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 12/12/2011] [Accepted: 12/16/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Celiac patients report fatigue and reduced social activities, which may decrease physical activity. This study investigated the physical activity, fatigue and bone mineral density in celiac women at diagnosis and during diet. MATERIALS AND METHODS The first group (n=48) had the bone mineral density measured at diagnosis and after 2 years of a gluten-free diet; in the second group (n=47) bone mineral density was measured at diagnosis and after 5 years of a gluten-free diet. Both groups completed a physical activity questionnaire and visual analogue scale for the perception of fatigue at diagnosis and follow-up. Data about smoking habits, alcohol use, presence of gastrointestinal symptoms, drug therapy and body mass index were also collected. RESULTS At diagnosis, the two groups were similar for all considered variables. At follow-up, the mean body mass index and physical activity questionnaire's score were similar to baseline. The bone density increased in both groups, whilst the physical activity questionnaire and visual analogue scale remained unchanged. CONCLUSION The improvement in bone density following a gluten-free diet was significant after 2 years; physical activity is frequently low and plays a minor role in determining the changes in bone mineral density.
Collapse
Affiliation(s)
- Valentina Passananti
- Department of Clinical and Experimental Medicine, University Federico II of Naples, Italy
| | | | | | | | | | | | | |
Collapse
|
47
|
Bone mineralization in celiac disease. Gastroenterol Res Pract 2012; 2012:198025. [PMID: 22737164 PMCID: PMC3378976 DOI: 10.1155/2012/198025] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/12/2012] [Accepted: 04/03/2012] [Indexed: 01/31/2023] Open
Abstract
Evidence indicates a well-established relationship between low bone mineral density (BMD) and celiac disease (CD), but data on the pathogenesis of bone derangement in this setting are still inconclusive. In patients with symptomatic CD, low BMD appears to be directly related to the intestinal malabsorption. Adherence to a strict gluten-free diet (GFD) will reverse the histological changes in the intestine and also the biochemical evidence of calcium malabsorption, resulting in rapid increase of BMD. Nevertheless, GFD improves BMD but does not normalize it in all patients, even after the recovery of intestinal mucosa. Other mechanisms of bone injury than calcium and vitamin D malabsorption are thought to be involved, such as proinflammatory cytokines, parathyroid function abnormalities, and misbalanced bone remodeling factors, most of all represented by the receptor activator of nuclear factor B/receptor activator of nuclear factor B-ligand/osteoprotegerin system. By means of dual-energy X-ray absorptiometry (DXA), it is now rapid and easy to obtain semiquantitative values of BMD. However, the question is still open about who and when submit to DXA evaluation in CD, in order to estimate risk of fractures. Furthermore, additional information on the role of nutritional supplements and alternative therapies is needed.
Collapse
|
48
|
Larussa T, Suraci E, Nazionale I, Leone I, Montalcini T, Abenavoli L, Imeneo M, Pujia A, Luzza F. No evidence of circulating autoantibodies against osteoprotegerin in patients with celiac disease. World J Gastroenterol 2012; 18:1622-7. [PMID: 22529691 PMCID: PMC3325528 DOI: 10.3748/wjg.v18.i14.1622] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 02/20/2012] [Accepted: 02/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate risk factors for low bone mineral density (BMD) in celiac disease (CD) patients, focusing on circulating autoantibodies against osteoprotegerin (OPG).
METHODS: Seventy asymptomatic CD adult patients on gluten-free diet (GFD) and harbouring persistent negative CD-related serology were recruited. Conventional risk factors for osteoporosis (e.g., age, sex, menopausal status, history of fractures, smoke, and body mass index) were checked and BMD was assessed by dual energy X ray absorptiometry. Serum calcium and parathyroid hormone (PTH) levels were evaluated. Thirty-eight patients underwent repeat duodenal biopsy. Serum samples from a selected sub-group of 30 patients, who were also typed for human leukocyte antigen (HLA) DQ2 and DQ8 haplotype, were incubated with homodimeric recombinant human OPG and tested by western blotting with an anti-OPG antibody after immunoprecipitation.
RESULTS: Despite persistent negative CD-related serology and strict adherence to GFD, 49 out of the 70 (74%) patients displayed low BMD. Among these patients, 13 (24%) showed osteoporosis and 36 (76%) osteopenia. With the exception of age, conventional risk factors for osteoporosis did not differ between patients with normal and low BMD. Circulating serum calcium and PTH levels were normal in all patients. Duodenal mucosa healing was found in 31 (82%) out of 38 patients who underwent repeat duodenal biopsy with 20 (64%) still displaying low BMD. The remaining 7 patients had an incomplete normalization of duodenal mucosa with 6 (84%) showing low BMD. No evidence of circulating antibodies against OPG was found in the serum of 30 celiac patients who were tested for, independent of BMD, duodenal histology, and HLA status.
CONCLUSION: If any, the role of circulating autoantibodies against OPG in the pathogenesis of bone derangement in patients with CD is not a major one.
Collapse
|
49
|
Jammah AA. A limp in a pregnant woman as a first presentation of celiac disease. Osteoporos Int 2012; 23:1183-6. [PMID: 21611842 DOI: 10.1007/s00198-011-1670-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
A 25-year-old Arab woman, reported to our endocrinology clinic one month post-partum presenting with back pain and a limp that started during the seventh month of pregnancy. Upon examination, she was found to have a full range of motion and no tenderness in the hip joint or lower back. The pain was aggravated by walking. She had a limping gait with a lean to her right side. She had low calcium, low hemoglobin, high parathyroid hormone and high alkaline phosphatase levels. X-rays of her hip and lumbosacral areas were normal. Her spinal magnetic resonance imaging findings were also normal. A bone mineral density (BMD) study revealed severe osteoporosis with a lumbar spine T-score of -4.6 and femoral neck T-scores of -4.1 (left) and -3.9 (right). A celiac disease work-up included tests for anti-endomysial antibodies and anti-tissue transglutaminase antibodies, which were positive, and the results of an endoscopy and biopsy confirmed the diagnosis of celiac disease. Gluten-free diet with calcium and vitamin D supplementation resulted in the complete resolution of her symptoms and a normal gait. The patient returned to normal calcium and parathyroid hormone levels and experienced a significant improvement in her BMD to normal. Celiac disease may initially presents during pregnancy result in severe osteoporosis that causes significant pain and disability.
Collapse
Affiliation(s)
- A A Jammah
- Department of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia.
| |
Collapse
|
50
|
Reyes García R, Jódar Gimeno E, García Martín A, Romero Muñoz M, Gómez Sáez JM, Luque Fernández I, Varsavsky M, Guadalix Iglesias S, Cano Rodriguez I, Ballesteros Pomar MD, Vidal Casariego A, Rozas Moreno P, Cortés Berdonces M, Fernández García D, Calleja Canelas A, Palma Moya M, Martínez Díaz-Guerra G, Jimenez Moleón JJ, Muñoz Torres M. [Clinical practice guidelines for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Bone Metabolism Working Group of the Spanish Society of Endocrinology]. ACTA ACUST UNITED AC 2012; 59:174-96. [PMID: 22321561 DOI: 10.1016/j.endonu.2012.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/10/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. PARTICIPANTS Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. METHODS Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. CONCLUSIONS The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed.
Collapse
|