Osteoporosis and celiac disease: is it useful to a new guideline?
Abstract
Celiac disease (CD) is a permanent glutensensitive enteropathy characterised by reversible small-bowel mucosal atrophy in a genetically predisposed person, resulting from an inappropriate immune response to dietary gliadin, a component of wheat proteins. CD can have a varied clinical presentation, with most symptoms being attributed to malabsorption [1]. CD has long been known to cause metabolic bone disease. Early reports focused mainly on the association with vitamin D deficiency and osteomalacia, but more recently attention has turned to Osteoporosis (OS) [2,3]. OS can be reliably detected by measurement of bone mineral density (BMD), which can be expressed as the number of standard deviation (SD) above or below either the mean BMD for young adults (T score) or the mean BMD for age matched controls (Z score). A BMD more than 2.5 SD below the mean for a young adult is generally taken to indicate OS [4]. Stratification for fracture risk is possible using BMD. The risk increases roughly twofold for each SD decline in BMD below the population mean. The risk of low BMD seems to rise with increasing age at diagnosis, decreased body weight and in postmenopausal women [5]. Low BMD can be detected even in children and adolescents with newly diagnosed CD [6]. Furthermore, the need to consider CD as a pathogenetic factor in individuals presenting with OS has been emphasised; this particularly applies to those with clinical features of the disease and those who fail to respond to…
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