Letter: limb, muscle, and bone in coeliac disease.

Abstract

Two recent articles in your journal highlight the role of inflammatory processes in the development of sarcopaenia and osteoporosis in inflammatory bowel disease (IBD).1, 2 It has also been suggested that coeliac patients may be similarly affected.3 We compared appendicular bone mineral density (BMD), lean and fat mass in male coeliac patients with controls to investigate whether results were similar to those recorded by Bryant et al.1 Thirty two male coeliac patients within 6 months of diagnosis referred by gastroenterologists for DEXA measurements were compared with data from 133 control subjects obtained for a separate study.4 Height was measured by a Harpenden Stadiometer. Measurements of body weight, lean, bone and fat were taken from the whole body DEXA scan done as part of the metabolic assessment. Shropshire pathology services measured parathyroid hormone (PTH) and total serum alkaline phosphatase (ALP). Appendicular lean mass index and appendicular BMD (Table 1) were significantly lower in upper and lower limbs in coeliac men with BMD Z scores at both sites lower than at the femoral neck (P < 0.02). In contrast femoral neck and spine BMD, fat mass indices, axial lean mass index and body weight showed no significant difference. ALP and PTH were slightly higher in coeliac men. No ALP values were above the upper limit of normal. These data suggest a deficit of appendicular lean mass index in coeliac disease, similar to that observed in males with IBD, a significantly low limb BMD (and lower than the femoral neck BMD), but with preservation of fat mass and of axial lean mass. Although malabsorption may play a role, gut inflammation may be a factor in common with IBD. Whether the bone deficit in both upper and lower limb is related to the inflammatory state or to the muscle deficit is uncertain, but withdrawal of gluten may reverse some changes.5 Declaration of personal and funding interests: MD is an Honorary Consultant Physician at Robert Jones and Agnes Hunt Hospital. SE is a Clinical Scientist employed by Robert Jones and Agnes Hunt Hospital. CS is a Senior Lecturer employed by the University of Chester.