Abstract
Aims. To investigate regional lower limb bone density and associations with weight, PTH, and bone breakdown in coeliac men. Methods. From whole body DXA scans bone mineral density (BMD) was measured in 28 coeliac men, in the lower limb (subdivided into 6 regions, 3 being metaphyseal (mainly trabecular) and 2 diaphyseal (mainly cortical)). BMD at femoral neck (FN) and lumbar spine L2–4, body weight, height, serum calcium, alkaline phosphatase, parathyroid hormone (PTH), and urinary calcium and NTx/Cr, a measure of bone breakdown, were also measured. Age matched healthy men provided values for BMD calculation of z and T scores and for biochemical measurements. Results. Low BMD z scores were found at metaphyseal regions in the leg (p < 0.001) and in the FN (p < 0.05). The distal metaphyseal region BMD in the leg was lower than spine or FN (p < 0.05). PTH, urinary calcium/creatinine, and urinary NTx/Cr were similar to controls. Both metaphyseal and diaphyseal BMD z scores were associated with body weight (p < 0.02), but not with either PTH or urinary NTx/Cr. Conclusions. Low BMD lower limb regions comprising mostly trabecular bone occur early in CD and in the absence of elevated PTH or increased bone resorption. Low BMD is associated with low body weight.
Highlights
Bone deficit in coeliac disease (CD) is well recognised [1]
In the present study we investigated areal bone mineral density (BMD) (BMD) in 6 regions of the lower limb to determine whether deficits of bone in the epiphyseal/metaphyseal region or diaphyseal regions occurred in the lower limbs of newly diagnosed patients with CD and to establish whether any deficit was associated with increased bone turnover, hyperparathyroidism, or body weight
In the biochemical measurements coeliac patients had higher alkaline phosphatase (ALP) than controls, but values for serum calcium, albumin, urinary Ca/Cr, and NTx/Cr were all similar to controls
Summary
Bone deficit in coeliac disease (CD) is well recognised [1]. This has been ascribed to the secondary hyperparathyroidism consequent upon the malabsorption of calcium and of vitamin D [2]. Two studies of lower tibial volumetric BMD may provide further reason to suspect that hyperparathyroidism is not the only factor affecting bone density in coeliac disease. These studies of trabecular and cortical bone in the peripheral skeleton in newly diagnosed patients with CD have disclosed a dichotomy in the response of trabecular and cortical bone density at the distal tibia using pQCT [7, 13]. Both reported a reduction in trabecular density, but only one study found a deficit of cortical density [13]
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