Bone mineral density directly correlates with duodenal Marsh stage in newly diagnosed adult celiac patients

Abstract

Objectives. To estimate the prevalence of low bone mineral density (BMD) in a prospective series of adult celiac patients and to identify nutritional and metabolic factors associated with osteoporosis and osteopenia. Methods. Patients over 18 years of age who were consecutively and newly diagnosed with celiac disease (CD) were recruited. A bone density scan with dual-energy X-ray absorptiometry was carried out on the left hip and lumbar spine; nutritional parameters were analyzed and a hormone study conducted in order to exclude secondary low BMD. Results. 40 patients (36 females/4 males) between the ages of 18 and 68 (mean 44.25 years) were recruited. Overall, at the moment of diagnosis 45% of patients exhibited low BMD at both demarcations. Risk of hip fracture was generally low, but ascended to mild in patients with villous atrophy (p = 0.011). Differences in major fracture risk were also observed depending on Marsh stage (p = 0.015). Significant differences were observed in nutritional status between patients with and without duodenal villous atrophy, with body mass index and blood levels of prealbumin, iron, vitamin D and folic acid significantly lower in Marsh III stage patients. No differences were found in blood hormone levels between Marsh stages or BMDs. The degree of bone mass loss in the lumbar spine directly correlated to Marsh stage. In the hip, a parallel association between BMD and Marsh stage was also observed, but did not reach statistical significance. Conclusion. Duodenal villous atrophy, through malabsorption, was the main determinant factor for low BMD in adult-onset CD patients.

Key Words::

• bone density scan
• bone mineral density
• celiac disease
• gluten enteropathy
• osteopenia
• osteoporosis

Acknowledgement

This work was supported by grant PI-2008/56 from the Castilla-La Mancha Health Research Foundation (Fundación para la Investigación Sanitaria de Castilla-La Mancha or FISCAM). AJ Lucendo: study conception and design, performance of endoscopic examinations and duodenal biopsies, data analysis and interpretation, drafting the manuscript, final approval of the manuscript. Á García-Manzanares: study conception and design, patient assistance, recording of data, data analysis and interpretation, drafting the manuscript, final approval of the manuscript. JM Tenias: study design, statistical analysis, data analysis and interpretation, final approval of the manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.