Bone loss prevalence in adult celiac disease and associated factors: Control case study

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Published Mar 5, 2012
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Vol. 90 No. 2 (2012): Issue Feb 2012

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Younes Mohamed
Ben Youssef Hedi
Leila Safer
Hassine Fadoua
Zrour Saoussen
Béjia Ismail
Touzi Mongi
Najjar Mohamed Fadhel
Hammouda Saffar
Bergaoui Naceur

Abstract

Background: Bone loss in celiac disease (CD) is important and is associated to increased risk of fractures. The determining factors of this Bone loss and the osteoporosis fracture during this disease remain still unknown. The bone remodeling parameters seem to play it an important role.
Aim: Through a transverse study including 30 patients with adult CD and 30 witnesses, we estimated bone mineral density (BMD) profile of these patients and determined associated factors to the bone loss.
Methods: Patients and witnesses benefited from an BMD measure, serum calcium and phosphore, alkaline phosphatasis, parathormone and hydroxyvitamin D dosage, bone remodeling parameters containing the osteocalcin, Propeptide N-terminal of the type I procollagen, BTélopeptide C-terminal ( B-CTX) of the type I procollagen I (bloody and urine CrossLaps). The patients benefited from a malabsorption bilan, a radiological examination of spine and an evaluation of the adhesion to the regime without gluten with a histological control.
Results: Our population consists of 3 men (10 %) and 27 women (90 %) with an average age of 30.4 years (19-50 years). The average delay of the diagnosis of the MC is of 46.7 months. The alkaline phosphatases, the P1NP and the bloody crossLaps were more raised at the patient's with regard to the witnesses with respectively p=0.038, p=0.041 and p=0.021. The parathormone was also more raised at the patients but without significant difference 67.8 vs 53.8 ng / l. The DMO is low at 21 patients (70 %) versus 2 witnesses only (6.6 %), with an osteoporosis in 3 patients (10 %) and an osteopenia in 18 patients (60 %). Factors associated to the BMD decline are low body mass index, nulliparity, diagnostic delay > to 2 years, the malabsorption syndrome, exaggerated intraepithelial lymphocytosis at the time of the histological control, an increase of bone remodeling parameters notably the alkaline phosphatasis, osteocalcin and bloody CrossLaps. While the BMD is more raised at the patient's having followed gluten regimens during more than 5 years. The age, the sex, the symptomatic character or not of the disease, the parathormone, hydroyviamin D and fractures are not correlated to the BMD profile patients.
Conclusion : The bone loss is more frequent during the adult CD than in the general population. His research has to become integrated into the coverage of this disease notably in the presence of risk factors. The absence of correlation between BMD loss and fractures underlines the importance of others factors in determining of bone fragility during this affection.

Keywords:

Celiac disease; osteoporosis; bone mineral density; bone remodeling parameters; adult.

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References

  1. Fasano A, Berti I, Gerarduzzi T et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003;163: 286-92.
  2. Bdioui F, Sakly N, Hassine M, Saffar H. Prevalence of celiac disease in Tunisian blood donors. Gastroenterol Clin Biol 2006; 30: 33-36.
  3. Ford A, Chey WD, Talley NJ et al. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome. Arch Intern Med 2009; 169: 651-658.
  4. Bianchi ML. Inflammatory bowel diseases, celiac disease, and bone. Arch Biochem Biophys. 2010; 503:54-65.
  5. Meyer D, Stavropolous S, Diamond B et al. Osteoporosis in a North American adult population with celiac disease. Am J Gastroenterol 2001 ; 96: 112-19.
  6. Scott EM, Gaywood I, Scott BB. Guidelines for osteoporosis in celiac disease and inflammatory bowel disease. Gut 2000 ; 46 : 11- 18.
  7. Lewis N, ScottB. Schould patients with celiac disease have their bone mineral density measured? Eur J Gastroenterol Hepatol 2005 ; 17 :¬ 1065-70.
  8. Fornari MC, Pedreira S, Niveloni S et al. Pre- and post- treatment serum levels of cytokines, IL-1 beta, IL-6 and IL-1 receptor antagonist in celiac disease: are they related to the osteopenia? Am J Gastroenterol 1998; 93: 413-18.
  9. Sategna-Guidelti C, Grosso SB, Grosso S, et al. The effect of one year gluten free-diet withdrawal on bone mass, bone metabolism, and nutritional status in newly-diagnosed adult celiac disease patients. Alim Pharmacol Ther 2000 ; 14 : 35-43.
  10. Mazure R, Vasquez H, Gonzalez D et al. Bone mineral affection in asymptomatic adult patients with celiac disease. Am J Gastroenterol 1994 ; 89 : 2130-34.
  11. Corazza GR, Di Sario A, Niveloni S et al. Influence of pattern of clinical presentation and on gluten free diet on bone mass and metabolism in adult celiac disease. Bone 1996 ; 18 : 525-30.
  12. Valdimarsson T, Toss G, Lofman O et al. Three years' follow-up of bone density in adult celiac disease: significance of secondary hyperparathyroidism. Scand J Gastroenterol 2000 ; 3 : 274-80.
  13. Stenson WF, Newberry R, Lorenz R et al. Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis. Arch Intern Med 2005 ; 165: 393-99.
  14. Armagan O, Uz T, Tascioglu F et al. Serological screening for celiac disease in premenopausal women with idiopathic osteoporosis. Clin Rheumatol 2005 ; 24: 239-43.
  15. Sanders DS, Patel D, Khan FB et al. Case-finding for adult celiac disease in patients with reduced bone mineral density. Dig Dis Sci 2005 ; 50: 587-92.
  16. Duerksen DR, Leslie WD. Positive celiac disease serology and reduced bone mineral density in adult women. Can J Gastroenterol 2010; 24:103-7.
  17. Sahli H, Kallel-Sellami M, Makdouli A, Sellami S, Makni S. Fautil rechercher systématiquement la maladie c?liaque chez les femmes souffrant d'une ostéoporose postménopausique ? Rev Rhum 2007 ; 74 : 914-23.
  18. Legroux-Gérot I, Leloire O, Blanckaert F et al. Intérêt du dépistage systématique de la maladie c?liaque chez des patients ostéoporotiques asymptomatiques. Rev Rhum 2009 ; 76 : 251-255.
  19. Corazza R, Di Sario A, Cecchetti L, Tarozzi C. Bone mass and metabolism in patients with celiac disease. Gastroenterol 1995; 109: 122-28.
  20. Gonzalez D, Mazure R, Mautalen C, Vazquez H, Bai J. Body composition and bone mineral density in untreated and treated patients with celiac disease. Bone 1995; 16: 231-234.
  21. Mustalahti K, Collin P, Sievänen H, Salmi J, Mäki M. Osteopenia in patients with clinically silent coeliac disease warrants screening. Lancet 1999; 354: 744-5.
  22. Corazza GR, Di Sario A, Cecchetti L et al. Influence of pattern of clinical presentation and of gluten-free diet on bone mass and metabolism in adult coeliac disease. Bone 1996 ; 18: 525-30.
  23. Mazure R, Vazquez H, Gonzalez D et al. Bone mineral affection in asymptomatic adult patients with celiac disease. Am J Gastroenterol 1994 ; 89: 2130-34.
  24. Kurppa K, Collin P, Sievänen H, Huhtala H, Mäki M, Kaukinen K. Gastrointestinal symptoms, quality of life and bone mineral density in mild enteropathic coeliac disease: a prospective clinical trial. Scand J Gastroenterol 2010; 45:305-14.
  25. Ferretti J, Mazure R, Tanoue P, Marino A. Analysis of the Structure and Strength of Bones in Celiac Disease Patients. Am J Gastroenterol 2003; 98: 382-90.
  26. Heymana R, Guggenbuhlb P, Corbela A et al. Effect of a gluten-free diet on bone mineral density in children with celiac disease. Gastroenterol Clin Biol 2009 ; 33: 109-14.
  27. Minisola S, Pacitti MT, Ombricolo E et al. Bone turnover and its relationship with bone mineral density in pre-and post menopausal women with or without fractures. Maturiatas 1998; 29: 265-70.
  28. Khosla S, Melton LJ, Atkinson EJ et al. Relationship of serum sex steroid levels and bone turnover markers with bone mineral density in men and women: A key role for bioavailable estrogen. J Clin Endocrinol Metab 1998; 83: 2266-74.
  29. Valdimarsson T, Toss G, Ross I, Lofman O, Strom M. Bone mineral density in celiac disease. Scand J Gastroenterol 1994; 29: 457-61.
  30. Hall NJ, Rubin G, Charnock A. Adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther 2009; 30:315-30.
  31. Mora S, Barera G, Beccio S et al. A prospective, longitudinal study of the long-term effect of treatment on bone density in children with celiac disease. J Pediatr 2001 ; 139: 516-21.
  32. Kemppainen T, Kro H, Janatuinen E, Arnala I, Lamberg A. Bone recovery after a gluten-free diet: A 5-year follow-up study. Bone 1999; 25: 355-60.
  33. Barera G, Beccio S, Proverbio MC, Mora S. Longitudinal changes in bone metabolism and bone mineral content in children with celiac disease during consumption of a gluten-free Diet. Am J Clin Nutr 2004; 79: 148-54.
  34. Ludvigsson JF, Michaelsson K, Ekbom A, Montgomery SM. Coeliac disease and the risk of fractures: a general population-based cohort study. Aliment Pharmacol Ther 2007; 25: 273-85.
  35. Matysiak-Budnik T, Malamut G, Serre NP et al. Long-term followup of 61 coeliac patients diagnosed in childhood: evolution toward latency is possible on a normal diet. Gut 2007; 56:1379-86.
  36. Thomason K, West J, Logan RF, Coupland C, Holmes G. Fracture experience of patients with coeliac disease: a population based survey. Gut 2003; 52: 518-22.
  37. Vestergaard P, Mosekilde L. Fracture risk in patients with celiac Disease, Crohn's disease, and ulcerative colitis: a nationwide follow-up study of 16,416 patients in Denmark. Am J Epidemiol 2002; 156: 1-10.
  38. Jafri MR, Charles W, Nordstrom J, Murray A. Long-term fracture risk in patients with celiac disease: A population-based study in Olmsted County, Minnesota. Dig Dis Sci 2008; 53: 964-971.
  39. Garnero P. Markers of bone turnover for the prediction of fracture risk. Osteoporosis Int 2000; 11 (suppl 6): S55-S65.
  40. Garnero P, Sornay-Rendu E, Duboeuf F, Delmas PD. Markers of bone turnover predicts postmenopausal forearm bone loss over 4 years: the OFELY study. J Bone Miner Res 1999; 14: 1614-21.