Celiac disease and bone health: is there a gap in the management of postmenopausal osteoporosis?

Abstract

Malabsorption due to celiac disease (CD) may contribute to postmenopausal osteoporosis. This study aimed to survey participants with CD regarding their bone density, fractures, and bone-preserving medications; to compare tolerance of bone-preserving medications in participants with and without CD; and to review the evidence for CD screening and osteoporosis therapies in the setting of CD. We recruited 131 participants with CD and 102 participants without CD. Of those with CD, 87% were diagnosed in adulthood and 40% had no recognized gastrointestinal symptoms. In 21% CD was diagnosed after the diagnosis of osteoporosis and in 9% after a fracture. No difference was found in the tolerability of bone medications between participants with CD and those without. Review of the literature found that, although monitoring of bone health is recommended for patients with CD, screening for CD is not generally accepted for patients with osteoporosis, although studies of the prevalence of CD in osteoporosis had incomplete ascertainment methods. There is a lack of well-conducted studies and therefore insufficient data for the efficacy and tolerability of bone medication in CD. In conclusion, both CD and menopause lead to bone loss. Identifying CD in postmenopausal women should lead to modification of osteoporosis management.

摘要

乳糜泻（CD）引起的吸收不良可能导致绝经后骨质疏松。本研究旨在调查CD患者的骨密度、骨质和治疗骨质疏松药物的有效性；比较有和没有乳糜泻患者对治疗骨质疏松药物的耐受性；并对乳糜泻筛查和骨质疏松症治疗的证据进行综述。我们招募了131名CD患者和102名非CD患者。在这些患者中, 87%的人在成年后被诊断出乳糜泻, 40%的患者没有发现胃肠症状。21%的乳糜泻是在骨质疏松症确诊之后诊断的, 9%是在骨折后确诊的。在治疗骨质疏松药物耐受性方面, 有CD和无CD的参与者之间没有发现差异。回顾文献发现, 虽然推荐对乳糜泻患者进行骨健康检查, 但对骨质疏松症患者进行乳糜泻筛查却不被普遍接受, 尽管关于乳糜泻在骨质疏松症中的患病率的研究并没有完整的研究方法。目前缺乏良好的研究, 因此也没有足够的数据说明治疗骨质疏松药物对乳糜泻的疗效和耐受性。总之, 乳糜泻和绝经都会导致骨质流失。在绝经后妇女中发现乳糜泻可通过治疗骨质疏松症得到改s善。

Keywords:

• Celiac disease
• bone density
• osteoporosis
• bisphosphonates
• denosumab
• screening

Acknowledgements

The authors thank all of the participants in the survey for their time and interest. They thank the Coeliac Society of Western Australia for their help in recruitment. They also thank Joanna Wagner and Jocelyn Tan for their help in recruitment and data entry.

Potential conflict of interest

No potential conflict of interest was reported by the author(s).

Source of funding

Nil.