Abstract

BIOCHEMICAL PARAMETERS OF BONE AND MINERAL METABOLISM IN CELIAC DESEASE.

Khodor Haidar Hassan*, Beatrice Paoli, Hala Khalife, Edwin Parra Prada, Zeinab Dirani and Fadi Abdel Sater

ABSTRACT

It is well known that osteopenia and osteoporosis are frequently found celiac disease patients presenting classical symptoms of malabsorption. A low bone mineral density (BMD) has been found in 70% of celiac disease patients (Meyer D., Stavropolous S., et al. 2001). In a prospective study, Margoni, et al. (2012) reported that approximately 30% of children with celiac disease had BMD below 2.5th percentile of the normal population at the time of diagnosis. (Sharma M, Singh P. et al. 2013). Osteoporosis can be observed in an asymptomatic celiac patient (Corazza GR., Di Sario A., et al. 1996; Kurppa K., Collin P., et al. 2010; Makharia GK., Baba CS., et al. 2007). Matysiak-Budnik et al. (2007) reported in series of 42 asymptomatic patients, 57% of cases present abnormalities of bone mineral density. In this study: The patients were subdivided in two subgroups: on a diet or not on a diet at the time of the first observation. Values of serum calcium, urinary calcium, parathormone and osteocalcin were measured in these patients using standard laboratory methods. BMD and biochemical parameters of bone and mineral metabolism were measured in 80 celiac disease patients between 23 and 74 years of age (mean ± SD = 44.7± 1.5). Conclusion: Our data show normal bone formation processes in most patients with celiac disease on gluten-free diet. However, the calcium malabsorption persists despite compliance with a gluten free diet. In addition, the concentration of vitamin D remained markedly low after 1 year of follow-up in some patients. There is evidence to suggest that initially high bone turnover in untreated celiac disease returns to normal after treatment with a gluten free diet. All patients with newly diagnosed coeliac disease need careful dietary advice, to accentuate compliance with a gluten free diet. We recommend calcium and vitamin D supplementation in adult celiac patients, especially at the beginning of treatment. Early diagnosis and treatment of CD, will protect patients from osteopenia.

Keywords: Bone mineral density (BMD), Celiac disease (CD), Standard deviation (SD), Dual Energy X-ray Absorptiometry (DEXA), Parathormone (PTH).