Original contributionOsteoporosis in a North American adult population with celiac disease1
Introduction
Celiac disease, or gluten-sensitive enteropathy, is caused by intolerance to gluten, occurring in genetically predisposed individuals (1). While celiac disease is common in Europe 2, 3, it is considered to be a rare disease in the United States (4). The reasons for this discrepancy are unclear, particularly since a recent study of healthy blood donors in Baltimore, MD found the prevalence of endomysial antibodies to be similar to that observed in Europe (5). This suggests that celiac disease may be underdiagnosed in the United States, either because of a low index of suspicion in American physicians 6, 7, 8 or because of a shift to a more silent form of the disease in which gastrointestinal symptoms are not prominent (9).
Within the past 10 yr, dual energy x-ray absorptiometry (DXA), a relatively inexpensive, accurate, and reproducible technique, has become available to physicians for measuring bone mineral density (BMD) (10). Several European and South American studies have now reported that bone mass is reduced in both treated and untreated adults and children with celiac disease 11, 12, 14, 15, 16, 17, 18, 19, 20. There are no published data on bone density in patients with celiac disease who reside in the United States. In an effort to determine the extent of skeletal demineralization associated with celiac disease in this country and whether they resembled celiac patients in other countries, we surveyed a group of adults with celiac disease.
Section snippets
Study design
We mailed a survey to 300 adults who had biopsy-proven celiac disease as identified from a databank at Columbia-Presbyterian Medical Center (21). In responding to a previous questionaire, these individuals had indicated that they had at least one BMD determination. Survey questions included: age, gender (and menopausal status), race, height, and weight; information on celiac disease, including age at diagnosis, symptoms at presentation (specifically, diarrhea), duration of gluten-free diet,
Study population
The study group Table 1, Table 2included 23 men, 26 premenopausal women, and 79 postmenopausal women, predominantly (n = 128) Caucasian. The average age was 56 yr (range, 21–83 yr). All claimed to adhere to a gluten-free diet (mean duration 9 ± 10 yr). The premenopausal women were approximately 2 decades younger than the men and postmenopausal women. Average age at diagnosis was 48 yr (range 6 months–83 yr), although the premenopausal women were diagnosed at a significantly younger age. Only 2
Discussion
In this study, BMD, measured predominantly in community-based settings, was evaluated in individuals with celiac disease residing in the United States. We noted, osteoporosis, as defined by the WHO, was common, as was low bone mass or osteopenia. In fact, only 28% of the participants in our study had normal BMD by these criteria. In 75% BMD was below average for their age, and in 46% it was more than one standard deviation below age-matched norms. Because the relative risk of fracture increases
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2022, Arthroplasty TodayCitation Excerpt :These results align with prior literature reporting on the negative impact of celiac disease on BMD and associated increased fragility fracture risk [10,13-16]. While BMD has been shown to significantly improve with treatment via GFDs, it has not been shown to normalize in all patients [9,13,15,16]. As a result, current guidelines recommend adult patients with celiac disease undergo routine screening with a dual-energy radiograph absorptiometry scan 1 year after the initiation of a GFD [17].
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This study was approved by the Institutional Review Board of Columbia-Presbyterian Medical Center.