Bone Metabolism and Osteoporosis in Adult Celiac Disease

Álvaro García Manzanares, Afredo J. Lucendo


Celiac disease (CD) affects around 1-2% of the world population. Many current CD patients live with their symptoms for years before diagnosis, and are therefore exposed to the consequences of the disease, including an impaired bone mineralization. In this chapter we provide an updated discussion on the relationship between low bone mineral density (BMD), osteopenia and osteoporosis, and celiac disease. Review of the literature shows, low BMD affects up to 75% of patients with celiac disease and 40% of those diagnosed during adulthood. It can be found at any age, independently of positive serological markers and presence of digestive symptoms, contributing to deterioration in the quality of life. The prevalence of CD among osteoporotic patients is also significantly increased. Two theories try to explain the origin of low BMD: Micronutrients malabsorption (including calcium and vitamin D) determined by villous atrophy has been related to secondary hyperparathyroidism and incapacity to achieve the potential bone mass peak; chronic inflammation was also related with RANKL secretion, osteoclasts activation and increased bone reabsorption. As a consequence, CD patients have a risk for bone fractures that exceeds 40% that of matched non-affected population. Treatment of low BMD in CD comprises gluten-free diet, calcium and vitamin D supplementation, and biphosphonates, although its effects on CD have not been specifically assessed. It can be concluded that a relevant proportion of CD patients present a low BMD and a variable increase in the risk of bone fractures. Epidemiological changes in CD make bone density scans more relevant for adult celiacs.

Palabras clave

celiac, osteoporosis, bone metabolism

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