The clinical impact of metabolic bone disease in coeliac disease

• Published in: Postgraduate medical journal Vol. 77; no. 903; pp. 33 - 36
• Main Authors: Fickling, W E, McFarlane, X A, Bhalla, A K, Robertson, D A F
• Format: Journal Article
• Language: English
• Published: London The Fellowship of Postgraduate Medicine 01.01.2001; BMJ; BMJ Publishing Group Ltd; Oxford University Press; BMJ Group
• Subjects: Absorptiometry, Photon - methods; Adult; Age; Aged; Biological and medical sciences; Bone density; Bone Density - physiology; Bone diseases; Bone Diseases, Metabolic - etiology; Bone Diseases, Metabolic - physiopathology; Causes of; Celiac disease; Celiac Disease - complications; Celiac Disease - physiopathology; coeliac disease; Diet; dual energyx ray absorptiometry; Female; Fractures, Spontaneous - etiology; Fractures, Spontaneous - physiopathology; Gastroenterology. Liver. Pancreas. Abdomen; Gluten; Humans; Male; Medical sciences; Metabolism; Middle Aged; Original; Osteoporosis; Other diseases. Semiology; Patients; Phosphatase; Physiological aspects; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Studies; Vitamin deficiency; United States; Human; Immunopathology; Diseases of the osteoarticular system; Nutrition disorder; Vitamin deficiency; Metabolic diseases; Bone disease; Review; Coeliac disease; Osteoporosis; Metabolic disorder; Intestinal malabsorption; Digestive diseases; Intestinal disease; Adult; Complication; Osteomalacia; Nutritional status
• ISSN: 0032-5473; 1469-0756
• DOI: 10.1136/pmj.77.903.33

Bone mineral density was measured by dual energyx ray absorptiometry (DEXA) at the lumbar spine and femoral neck in 15 adults who had metabolic bone disease in association with coeliac disease (mean age at diagnosis 53.5 years, range 37 to 66). Results were expressed as a T score (the number of standard deviations by which patient's bone density differed from the sex matched young adult mean). Three patients had no skeletal symptoms and normal routine calcium biochemistry but severely reduced axial bone mineral density on DEXA. Eleven patients had symptomatic skeletal fractures, including fractures of proximal femur (3), vertebrae (4), and radius (6). Three patients had osteomalacia confirmed on bone biopsy, two of whom had characteristic biochemistry. Secondary and tertiary hyperparathyroidism were seen. Seventy five further patients (60 female) with coeliac disease (mean age 52.0 years, median duration of gluten-free diet 3.4 years) and 75 paired healthy age and sex matched controls were questioned on past fracture history. Patients with coeliac disease underwent detailed studies of calcium biochemistry, dietary intake, and bone mineral density. Sixteen had a past history of fractures (χ2 = 10.7, p = 0.0004,v controls), which were of typical osteoporotic type. Ten patients had fracture before diagnosis of coeliac disease and six after diagnosis. Patients who had a fracture were older (56.3 v 50.3 years, p < 0.02, Wilcoxon rank sum test) than those with no fracture. There was no significant difference in bone mineral density (z score −0.31v −0.77), serum calcium (2.30v 2.26 mmol/l), 25-hydroxyvitamin D (19.7v 23.7 nmol/l), parathyroid hormone (2.6v 3.1 pmol/l), or dietary calcium intake (1021.0 v 1033.0 mg/day) in patients with fracture compared with those without fracture. Metabolic bone disease is common in coeliac disease and is associated with premature osteoporotic fractures.