Osteoporosis and Other Bone Disease

The Gluten File



PubMed Abstracts

Although common serological tests are available to diagnose celiac disease, the diagnosis of celiac disease is often delayed or missed because of lack of recognition as the disease presentation in adults is highly variable and may be asymptomatic.Celiac disease is a common secondary cause of metabolic bone disease and delayed treatment with gluten-free diet affects bone mineral density and fracture risk, so it is crucial to diagnose and treat celiac disease promptly. 
Celiac Disease and Metabolic Bone Disease.
PMID:24090646  Sept 2013

GFD has a beneficial effect on bone health. Two years receiving diet do not ensure normalization. Biochemical markers are not indicative of BMD disturbances. Dual x-ray absorptiometry should be included in the standard management of children with CD.
Bone health in children with celiac disease assessed by dual x-ray absorptiometry: effect of gluten-free diet and predictive value of serum biochemical indices.

PMID:22094895 May 2012

CD patients have higher prevalence of fractures in the peripheral skeleton before diagnosis. This is associated with male sex and classic clinical presentation. The fracture risk was reduced after the treatment.
Risk of fracture in celiac disease: gender, dietary compliance, or both?
PMID:21799650  July 2011

The aim of this study was to analyse the clinical manifestations and the most frequent causes of osteomalacia (OM) in a group of 28 patients diagnosed with this disorder during a 20-year period. OM was diagnosed by bone biopsy and/or by Bingham and Fitzpatrick criteria (two of the following: low calcium, low phosphate, elevated total alkaline phosphatase [total AP] or suggestive radiographs). Of these patients, 13 had vitamin D deficiency OM (VD-OM), 14 hypophosphatemic OM (HypoP-OM) and one had OM-associated hypophosphatasia. Deficient sun exposure and celiac disease were the most frequent etiologies of VD-OM,whereas most HypoP-OM were hereditary forms.
Osteomalacia revisited : A report on 28 cases.
PMID: 20949298  Oct 2010

RESULTS: BMD in patients on strict GFD was significantly higher than in patients on not strict GFD (lumbar p=0.01; total body p=0.005). There were significantly more patients with total body BMD below -1.0 in not strictly compliant group (71% compared to 38%; p=0.03). Calcium intake and vitamin D levels were below recommendations in both groups. CONCLUSION: Children and adolescents on not strict GFD are at increased risk for low BMD. We therefore recommend that BMD should be evaluated in patients with positive EMA. In addition, patients on strict GFD are at risk for low BMD because of low calcium intake or vitamin D deficiency. Therefore, strict GFD with recommended calcium intake and vitamin D supplementation during winter and spring should be encouraged in all children and adolescents with celiac disease
Bone mineral density and importance of strict gluten-free diet in children and adolescents with celiac disease.

PMID: 20601293  June 2010

The article summarizes the current knowledge on the pathogenesis, clinical aspects and treatment of bone problems in the major inflammatory bowel diseases (Crohn's disease and ulcerative colitis) and celiac disease. It presents the physiological relationship between intestine and bone as well as the alterations determined by disease-disrupted intestinal integrity. Two hypotheses about the pathogenetic mechanisms of bone metabolism derangements and bone loss are discussed: the classical one, that indicates calcium malabsorption as the main culprit, and the new one, that emphasizes the role of inflammation. The article summarizes the available epidemiological data about osteopenia/osteoporosis and fragility fractures in these chronic intestinal diseases and presents the state-of-the-art treatment options.
Inflammatory bowel diseases, celiac disease, and bone.
PMID: 20599670
  July 2010

RESULTS: There was significantly lower bone density in TTG/EMA seropositive women than with seronegative controls for all sites tested (lumbar spine, total hip, trochanter, femoral neck; all P<0.05). TTG/ EMA seropositive women also had a significantly higher prevalence of osteoporosis (67.7% versus 44.8%; P<0.05). There was lower bone density at the three hip sites (all P<0.05) in AGA seropositive women, but after excluding TTG/EMA seropositive women, isolated AGA seropositivity showed no significant association with any bone density measurements. CONCLUSION: TTG/EMA seropositivity was associated with lower bone density and a higher prevalence of osteoporosis compared with seronegative controls.
Positive celiac disease serology and reduced bone mineral density in adult women.
Duerksen DR, Leslie WD.
Can J Gastroenterol. 2010 Feb;24(2):103-7.
PMID: 20151068

A 45 year-old woman presented with late-diagnosed celiac disease, marked disorders of calcium and bone metabolism, and severe osteoporosis. Weak enteral symptoms delayed diagnosis.
[Late diagnosis of celiac disease]
[No authors listed]
Klin Med (Mosk). 2009;87(12):62-4. Russian.
PMID: 20135891

Autoantibodies against osteoprotegerin, which block the inhibitory effect of osteoprotegerin on signaling by the receptor activator of nuclear factor (NF)-kappaB (RANK), were identified in a man with celiac disease who presented with severe osteoporosis and high bone turnover. The osteoporosis did not respond to the treatment of his celiac disease but was completely reversed by bisphosphonate therapy. Autoantibodies against osteoprotegerin were detected in three additional patients with celiac disease. Such autoantibodies may be associated with the development of high-turnover osteoporosis, but whether autoantibodies against osteoprotegerin commonly contribute to the pathogenesis of osteoporosis in patients with celiac disease remains to be determined.
Osteoporosis associated with neutralizing autoantibodies against osteoprotegerin.
PMID: 19812402  Oct 2009

Bone involvement in clusters of autoimmune diseases: Just a complication?
PMID: 19815104  Oct 2009

Reduced bone mineral density (BMD) is frequently found in individuals with untreated celiac disease (CD), possibly due to calcium and vitamin D malabsorption, release of pro-inflammatory cytokines, and misbalanced bone remodeling. A gluten-free diet (GFD) promotes a rapid increase in BMD that leads to complete recovery of bone mineralization in children. Children may attain normal peak bone mass if the diagnosis is made and treatment is given before puberty, thereby preventing osteoporosis in later life. A GFD improves, but rarely normalizes, BMD in patients diagnosed with CD in adulthood. In some cases, nutritional supplementation may be necessary. More information on therapeutic alternatives is needed.
Metabolic osteopathy in celiac disease: importance of a gluten-free diet.
PMID: 19785691  Oct 2009

Celiac disease (nontropical sprue) is autoimmune disorder of the intestinal mucose, which usually develops in humans hypersensitive to gluten. The disease can occur at any age, with the greatest occurrence in early adulthood. Besides intestinal symptomatology--abdominal pain, diarrhoea and weight loss--celiac disease is often accompanied by extra-intestinal complications including osteopenia or osteoporosis and osteomalacia. Overproduction of cytokines IL-1 alpha, IL-1 beta and TNF-alpha increases bone resorption, which is further accelerated by hyperparathyroidism connected with malabsorption of calcium and vitamin D. Interaction of both these mechanisms activated bone loss.
[Celiac disease and its relation to bone metabolism]
PMID: 19642305   2009

CONCLUSIONS:: An equivalent reduction in spine bone mass was observed in children with celiac disease at diagnosis regardless of the presence of symptoms. Delayed diagnosis of children with celiac disease may increase the risk of adult osteoporosis. Appropriate screening of children at risk of celiac disease for the purpose of early diagnosis, as well as routine evaluation of bone mineral density in such children, are important to prevent long-term complications associated with poor bone health.
Prevalence of Metabolic Bone Disease in Children With Celiac Disease Is Independent of Symptoms at Diagnosis.
PMID: 19644400  July 2009

Coeliac disease presenting with bilateral fibular stress fractures.
PMID: 19410177  July 2009

Coeliac disease-specific tissue transglutaminase autoantibodies are associated with osteoporosis and related fractures in middle-aged women.
PMID: 19255929  Mar 2009

RESULTS: Forty-four children (mean age 10.6 +/- 3.4 years; 77% female, 96% white) with CD were evaluated and compared with 338 healthy children. Children with CD were shorter than children of similar age and sex. SP and WB BMC for age z scores were significantly lower in the CD group compared with controls. When adjusted for height, significant deficits in WB BMC persisted in patients with CD. Low SP and WB BMC correlated with advanced histological grade in CD. Low body mass index correlated with low WB BMC in CD. CONCLUSIONS: Newly diagnosed children with CD may benefit from screening for low bone mineral content. Patients with low body mass index and those with advanced histological damage (Marsh grade IIIc) particularly may be at risk for osteopenia.
Bone mineral content deficits of the spine and whole body in children at time of diagnosis with celiac disease.
PMID: 19179879  Feb 2009

CONCLUSION: Celiac children not following a GFD show delays in both bone maturation and mineralization. This prospective study confirms the importance of maintaining a GFD in children with celiac disease until the end of skeletal mineralization even in asymptomatic patients following a non-restricted diet.
Effect of a gluten-free diet on bone mineral density in children with celiac disease.
PMID: 19201117 Feb 2009

Disabling osteomalacia and myopathy as the only presenting features of celiac disease: a case report.
PMID: 19128487  Jan 2009

Celiac disease (CD), also known as gluten-sensitive enteropathy, is an inherited autoimmune disease that can lead to multisystem effects. Left undiagnosed and untreated, it has severe orthopaedic implications involving osteoporosis and unnecessary treatment of joint pain, which could be avoided. The orthopaedic nurse may have thought that CD was primarily an abdominal disorder. We need to be aware of the potential practice implications in orthopaedics by understanding the disease, its diagnosis, and treatment. Furthermore, orthopaedic nurses can contribute to current research by studying the relationships between CD and orthopaedic problems.
Celiac disease: its implications for orthopaedic nursing.
PMID: 18832989  Sept 2008

Gluten withdrawal is able to restore bone mass quite rapidly, with a normalization of levels of bone formation and bone resorption markers. Good adherence to gluten-free diet is mandatory to maintain optimal bone health. Monitoring of dietary compliance is important to ensure appropriate bone mass accrual through childhood and puberty in these patients, to maximize peak bone mass and reduce fracture risk later in life.
Celiac disease in children: Impact on bone health.
PMID: 18247120  Feb 2008

Pathological conditions such as celiac disease (CD) exacerbate the process of bone loss, so that the occurrence of osteoporosis in celiac subjects is of particular note: indeed, the screening of osteoporosis patients for this disease is advisable, since it may be the only sign of undiagnosed CD.
Osteoporosis in celiac disease and in endocrine and reproductive disorders.
PMID: 18203279   Jan 2008 

CONCLUSION: The above results confirm the need for serological screening for CD in premenopausal and early postmenopausal patients with "idiopathic osteoporosis".
[Celiac disease--a frequent cause of "idiopathic osteoporosis" in premenopausal and early postmenopausal women]
PMID: 18357865  Dec 2007

Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County, Minnesota.
PMID: 17934823 Oct 2007

One year after gluten-free diet, patient improved of malabsorptive symptoms and gained BMD (47.3% in spine and 31.6% in femoral neck), confirming the hypothesis of celiac disease as aggravating factor of osteoporosis in this patient.
[Case report: recently diagnosed celiac disease as aggravating factor of osteoporosis in old woman.]
PMID: 17221122  Dec 2006

Bone mineral density, determined by dual-energy x-ray absorptiometry, was in the osteopenic range at the femoral neck. The initiation of a gluten-free diet resulted in correction of all biochemical abnormalities and a substantial increase in bone mineral density.
Celiac disease manifesting as isolated hypocalcemia. PMID: 15310538 June 2004

Calcium malabsorption, hypocalcemia and skeletal demineralization are well-recognized features of untreated celiac disease. This study investigates calcium absorption and bone mineral density (BMD) after a prolonged, over 4 years, treatment with a gluten-free diet.
Calcium absorption and bone mineral density in celiacs after long term treatment with gluten-free diet and adequate calcium intake
PMID: 15221205 Jan 2005

The identification of the etiology of metabolic bone disease that leads to myopathy is important as this type of muscle weakness often responds fully to treatment.
Proximal muscle weakness--an unusual presentation of celiac disease
PMID: 12521285

Clinical examination showed evidence of bilateral, proximal muscle atrophy and weakness in the lower limbs. Low serum calcium and raised serum alkaline phosphatase, coupled with radiological findings, led to the diagnosis of osteomalacia.
Disabling osteomalacic myopathy as the only presenting feature of coeliac disease
PMID: 12439125

Osteopenia and osteoporosis are well-known complications detected in celiac disease patients with still obscure pathogenesis. In the present study we investigated the presence of circulating anti-bone autoantibodies in patients with celiac disease and explored their role in the associated bone disease.
Bone-specific antibodies in sera from patients with celiac disease: characterization and implications in osteoporosis
PMID: 12462335

Among the extra-intestinal alterations, bone mass decrease and bone metabolism derangement are frequently present and can be the only signs of an otherwise silent celiac disease.
Bone and celiac disease
PMID: 12232681

Causes of osteoporosis: don't forget celiac disease

PMID: 12715291