Measuring bone mineral density in celiac disease patients
Katy Cherry
Original article
Lewis NR and Scott BB (2005) Should patients with celiac disease have their bone mineral density measured? Eur J Gastroenterol Hepatol 17: 1065–1070 PubMed
Guidelines for the management of osteoporosis in patients with celiac disease were published by Scott and colleagues in 1998. On the basis of previous studies that suggested untreated celiac disease was associated with reduced bone mineral density (BMD) they recommended that BMD should be measured at the time of diagnosis. Since the guidelines were published, however, studies have found a relatively low risk of fragility fractures in celiac disease patients. Lewis and Scott have now analyzed data from patients managed according to the guidelines at a district general hospital, with the intention to rationalize the screening approach.
In total, 43 patients with newly diagnosed celiac disease were assessed by dual-energy X-ray absorptiometry to determine BMD at the lumbar spine and hip. Osteoporosis of the spine was present in 14% of patients and osteoporosis of the hip in 7%. When corrected for age using the z score, however, there was no significant reduction in BMD at the hip or spine. When factors thought to influence BMD were considered, no significant correlation was found between BMD at the spine or hip and the duration of exposure to gluten, degree of villous atrophy or smoking. BMI, however, correlated significantly with BMD at the hip (P = 0.0154), but not at the spine.
Owing to the low prevalence of reduced BMD in this sample of patients, the authors suggest that the guidelines be changed, as screening of all patients at diagnosis cannot be adequately justified.
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Subject areas under which this article appears: Nutrition
