Osteoporosis and bone alterations in celiac disease in adults

Czech version

Authors: Iva Hoffmanová; Michal Anděl
Authors‘ workplace: II. interní klinika 3. LF UK a FN Královské Vinohrady, Praha, přednosta prof. MUDr. Michal Anděl, CSc.
Published in: Vnitř Lék 2014; 60(7-8): 601-606
Category: Reviews

Overview

Both celiac disease and osteoporosis are common diseases which are considered an emerging problem in medicine. Celiac disease is a condition at high risk for secondary osteoporosis. Osteoporosis or osteopenia are typically present in untreated adult symptomatic celiac disease with an overt malabsorption syndrome, but is found in about 50 % in suboptimally treated celiac patients, subclinical patients and asymptomatic adult celiac patients, too. Etiology of pathologic bone alteration in celiac disease is multifactorial; however, two main mechanisms are involved: intestinal malabsorption and chronic inflammation. The evaluation of bone mineral metabolism (total calcium/albumin, 25-OH vitamin D₃ and parathormone levels in serum) and bone mineral density (densitometry) is recommended in the clinical management of celiac patients. Many studies have demonstrated that bone mineral density values in adults show a good improvement in the first period after the institution of gluten-free diet, the improvement is then unsatisfactory and treatment with a mineral-active drug should probably be considered.

Key words:
bone mineral density –⁠ bone mineral metabolism –⁠ celiac disease –⁠ densitometry –⁠ gluten-free diet –⁠ osteoporosis –⁠ intestinal inflamation –⁠ malabsorption

Sources

1. Guandalini S, Assiri A. Celiac disease. a review. JAMA Pediatr 2014; 168(3): 272–278.

2. Vančikova Z, Chlumecky V, Sokol D et al. The serologic screening for celiac disease in the general population (Blood donors) and in some high-risk groups of adults (patients with autoimmune disease, osteoporosis and infertility) in the Czech Republic. Fol Microbiol (Praha) 2002; 47(6): 753–758.

3. Rios LP, Khan A, Sultan M et al. Approach to diagnosing celiac disease in patients with low bone mineral density or fragility fractures: multidisciplinary task force report. Can Fam Physician 2013; 59(10): 1055–1061.

4. Fojtík P, Novosad P, Kliment M et al. Screening celiakie u pacientů s osteoporózou a osteopenií. Vnitř Lék 2011; 57(12): 1000–1005.

5. Di Stefano M, Mengoli C, Bergonzi M et al. Bone mass and mineral metabolism alterations in adult celiac disease: pathophysiology and clinical approach. Nutrients 2013; 5(11): 4786–4799.

6. Fouda MA, Khan AA, Sultan MS et al. Evaluation and management of skeletal health in celiac disease: position statement. Can J Gastroenterol 2012; 26(11): 819–829.

7.WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Levels. Summary Meeting Report 2004 Brussels, Belgium, 5–7 May 2004. World Health Organization: Geneva 2007 : 1–17. Dostupné z WWW: <http://www.who.int/chp/topics/Osteoporosis.pdf>.

8. Štěpán J. Algoritmus diagnostiky a léčby osteoporózy. Farmakoterapie 2005; 1(5): 485–494.

9. Tack GJ, Verbeek WHM, Schreurs MWJ et al. The spectrum of coeliac disease: epidemiology, clinical aspects and treatment. Nat Rev Gastroenterol Hepatol 2010; 7(4): 204–213.

10. Lebwohl B, Rubio-Tapia A, Assiri A et al. Diagnosis of celiac disease. Gastrointest Endosc Clin N Am 2012; 22(4): 661–677.

11. Rostom A, Dubé C, Cranney A et al. The diagnostic accuracy of serologic tests for celiac disease: a systematic review. Gastroenterology 2005; 128(4 Suppl. 1): S38-S46.

12. Vande Voort JL, Murray JA, Lahr BD et al. Lymphocytic duodenosis and the spectrum of celiac disease. Am J Gastroenterol 2009; 104(1): 142–148.

13. Consensus development conference: Prophylaxis and treatment of osteoporosis. Osteoporos Int 1991; 1(2): 114–117.

14. West J, Logan RF, Card TR et al. Fracture risk in people with celiac disease: a population-based cohort study. Gastroenterology 2003; 125(2): 429–436.

15. Ludvigsson JF, Michaelsson K, Ekbom A et al. Coeliac disease and the risk of fractures –⁠ a general population-based cohort study. Aliment Pharmacol Ther 2007; 25(3): 273–285.

16. Olmos M, Antelo M, Vazquez H et al. Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease. Dig Liver Dis 2008; 40(1): 46–53.

17. García-Manzanares A, Tenias JM, Lucendo AJ. Bone mineral density directly correlates with duodenal Marsh stage in newly diagnosed adult celiac patients. Scand J Gastroenterol 2012; 47(8–9): 927–936.

18. Krupa-Kozak U. Pathologic bone alterations in celiac disease: etiology, epidemiology, and treatment. Nutrition 2014; 30(1): 16–24.

19. Keaveny AP, Freaney R, McKenna MJ et al. Bone remodelling indices and secondary hyperparathyroidism in coeliac disease. Am J Gastroenterol 1996; 91(6): 1226–1231.

20. Plotkin GR, Isselbacher KJ. Secondary disaccharidase deficiency in adult celiac disease (Nontropical Sprue) and other malabsorption states. N Engl J Med 1964; 271 : 1033–1037.

21. Molteni N, Bardella MT, Vezzoli G et al. Intestinal calcium absorption as shown by stable strontium test in celiac disease before and after gluten-free diet. Am J Gastroenterol 1995; 90(11): 2025–2028.

22. Selby P, Davies M, Adams J et al. Bone loss in celiac disease is related to secondary hyperparathyroidism. J Bone Miner Res 1999; 14(4): 652–657.

23. Kemppainen T, Kröger H, Janatuinen E et al. Osteoporosis in Adult Patients With Celiac Disease. Bone 1999; 24(3): 249–255.

24. Zanchi C, Di Leo G, Ranfani L et al. Bone metabolism in celiac disease. J Pediatr 2008; 153(2): 262–265.

25. Staun M, Jarnum S. Measurement of the 10,000-molecular weight calcium-binding protein in small-intestinal biopsy specimens from patients with malabsorption syndromes. Scand J Gastroenterol 1998; 23(7): 827–832.

26. Sun J. Vitamin D and mucosal immune function. Curr Opin Gastroenterol 2010; 26(6): 591–595.

27. Kong J, Zhang Z, Musch MW et al. Novel role of the vitamin D receptor in maintaining the integrity of intestinal mucosal barrier. Am J Physiol Gastrointest Liver Physiol 2008; 294(1): G208-G216.

28. Valdimarsson T, Arnqvist HJ, Toss G et al. Low circulating insulin-like growth factor i in coeliac disease and its relation to bone mineral density. Scand J Gastroenterol 1999; 34(9): 904–908.

29. Jameson S. Coeliac disease, insulin-like growth factor, bone mineral density, and zinc. Scand J Gastroenterol 2000; 35(8): 894–896.

30. Fornari MC, Pedriera S, Niveloni S et al. Pre -⁠ and post-treatment serum levels of cytokines IL-1beta, IL-6, and IL-1 receptor antagonist in coeliac disease. Are they related to the associated osteopenia? Am J Gastroenterol 1998; 93(3): 413–418.

31. Taranta A, Fortunati D, Longo M et al. Imbalance of osteoclastogenesis-regulating factors in patients with coeliac disease. J Bone Miner Res 2004; 19(7): 1112–1121.

32. Wei S, Kitaura H, Zhou P et al. IL-1 mediates TNF-induced osteoclastogenesis. J Clin Invest 2005; 115(2): 282–290.

33. Khosla. Minireview: The OPG/RANKL/RANK system. Endocrinology 2001; 142(12): 5050–5055.

34. Fiore CE, Pennisi P, Ferro G et al. Altered osteoprotegerin/RANKL ratio and low bone mineral density in celiac patients on long-term treatment with gluten-free diet. Horm Metab Res 2006; 38(6): 417–422.

35. Riches PL, McRorie E, Fraser WD et al. Osteoporosis associated with neutralizing autoantibodies against osteoprotegerin. N Engl J Med 2009; 361(15): 1459–1465.

36. Larussa T, Suraci E, Nazionale I et al. No evidence of circulating autoantibodies against osteoprotegerin in patients with celiac disease. World J Gastroenterol 2012; 18(14): 1622–1627.

37. Smecuol E, Maurino E, Vazquez H et al. Gynaecological and obstetric disorders in coeliac disease: frequent clinical onset during pregnancy or the puerperium. Eur J Gastroenterol Hepatol 1996; 8(1): 63–89.

38. Ozgör B, Selimoğlu MA Coeliac disease and reproductive disorders. Scand J Gastroenterol 2010; 45 : 395–402.

39. Kanis JA, Burlet N, Cooper C et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2008; 19(4): 399–428.

40. Scott EM, Gaywood I, Scott BB Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease. Gut 2000; 46(Suppl 1): i1-i8.

41. American Gastroenterological Association medical position statement: guidelines on osteoporosis in gastrointestinal diseases. Gastroenterology 2003; 124(3): 791–794.

42. Kemppainen T, Kröger H, Janatuinen E et al. Bone recovery after a gluten-free diet: a 5-year follow-up study. Bone 1999; 25(3): 355–360.

43. Reuss-Borst MA. Metabolic bone disease osteomalacia. Z Rheumatol 2014; 73(4): 316–322.