B-vitamin status in relation to bone mineral density in treated celiac disease patients

Abstract

Objectives. Patients with celiac disease (CD) are at increased risk of osteoporosis and compromised B-vitamin status. Emerging evidence supports a beneficial role of folate and the metabolically related B-vitamins in bone health in generally healthy adults, but no previous study has investigated this in CD patients. The aim of the current study was to examine the relationship of folate, vitamins B12, B6 and B2 (riboflavin), and the related metabolite homocysteine, with bone mineral density (BMD) in CD patients. Materials and methods. Of the 400 treated adult CD patients invited to participate, 110 responded and met the eligibility criteria for study participation. BMD was measured using dual energy X-ray absorptiometry scanning at the lumbar spine (L1–L4), femoral neck, and total hip sites. Biomarker status of the relevant B-vitamins and homocysteine, and dietary B-vitamin intakes, were measured. Results. The significant predictors of low BMD were increasing age (B = 0.080, p < 0.001) and decreasing weight (B = 0.072, p = 0.004), whereas no significant relationship with serum 25-hydroxyvitamin D (B = 0.093, p = 0.928) was observed. Following adjustment for these predictors, serum vitamin B12 (but no other B-vitamin biomarker) was found to be a significant determinant of BMD at the femoral neck (β = 0.416, p = 0.011) and total hip (β = 0.327, p = 0.049) in men only. No significant relationships were found between any of the B-vitamin biomarkers investigated and BMD (at any measured site) in women. Conclusion. These findings add to current evidence suggesting a potential role of vitamin B12 in BMD, particularly in men, and show such a relationship for the first time in CD patients.

Key Words:

• bone
• celiac disease
• osteoporosis
• vitamin B
• vitamin B12

Acknowledgements

The authors wish to thank all of the study participants. Guarantor of the article: HeleneMcNulty. Principal investigator: Helene McNulty. Planning, design, and supervision of the study: William Dickey, Helene McNulty, Mary Ward, and Leane Hoey. Clinical collaborators: William Dickey and Abraham Varghese. Study execution, statistical analysis, and drafting of the manuscript: Michelle Clarke. B-vitamin biomarker analysis: Anne Molloy and Adrian McCann. Dietary analysis: Lisa Waldron. Statistical Advice: Jaine Blayney. All authors were involved in manuscript revisions, critical review, and final drafting of the manuscript. This study was supported in part by the Department for Employment and Learning, Northern Ireland (funding for a PhD studentship: MC) and in part by the National Osteoporosis Society, UK (Reference No. 97/308).

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