Abstract
Impairment of bone mineral density (BMD) is frequent in celiac disease (CD) patients on a gluten-free diet (GFD). The normalization of intestinal mucosa is still difficult to predict. We aim to investigate the relationship between BMD and duodenal mucosa healing (DMH) in CD patients on a GFD. Sixty-four consecutive CD patients on a GFD were recruited. After a median period of a 6-year GFD (range 2–33 years), patients underwent repeat duodenal biopsy and dual-energy X-ray absorptiometry (DXA) scan. Twenty-four patients (38%) displayed normal and 40 (62%) low BMD, 47 (73%) DMH, and 17 (27%) duodenal mucosa lesions. All patients but one with normal BMD (23 of 24, 96%) showed DMH, while, among those with low BMD, 24 (60%) did and 16 (40%) did not. At multivariate analysis, being older (odds ratio (OR) 1.1, 95% confidence interval (CI) 1.03–1.18) and having diagnosis at an older age (OR 1.09, 95% CI 1.03–1.16) were associated with low BMD; in turn, having normal BMD was the only variable independently associated with DMH (OR 17.5, 95% CI 1.6–192). In older CD patients and with late onset disease, BMD recovery is not guaranteed, despite a GFD. A normal DXA scan identified CD patients with DMH; thus, it is a potential tool in planning endoscopic resampling.
Highlights
Celiac disease (CD) is a chronic autoimmune disorder occurring in genetically predisposed individuals, triggered by gluten and related prolamins contained in wheat, barley, and rye.The resulting malabsorption due to small intestinal injury leads to systemic damage, mostly related to nutritional deficiencies [1]
Incomplete mucosal recovery represents a challenge for clinicians, since it can occur in apparently asymptomatic CD patients despite adequate gluten-free diet (GFD) and negative serology [13]. These findings suggest the importance of a follow-up biopsy after CD diagnosis and the need for parameters other than serology or dietary assessment to target the optimal timing of the endoscopic repeat procedure
Age at diagnosis, and body mass index (BMI) closely approached statistical significance, at multivariate analysis, a normal bone mineral density (BMD) was the only variable independently associated with duodenal mucosa healing (DMH)
Summary
Celiac disease (CD) is a chronic autoimmune disorder occurring in genetically predisposed individuals, triggered by gluten and related prolamins contained in wheat, barley, and rye.The resulting malabsorption due to small intestinal injury leads to systemic damage, mostly related to nutritional deficiencies [1]. Serological screening tests are available to select individuals needing to undergo diagnostic endoscopic biopsy of the duodenal mucosa. They are immunoglobulin (Ig)A anti-tissue transglutaminase (tTG) and anti-endomysium antibodies-IgA (EMA), both showing a specificity close to 100% and a sensitivity greater than 90% [2]. It is conceivable that chronic inflammation can predispose CD patients, whether on a GFD or not, to mineral metabolism derangement [5]. A lack of calbindin and calcium-binding protein, the vitamin D-regulated protein implicated in calcium uptake from the intestinal lumen, has been described in the areas of damaged mucosa [6]. Hyperparathyroidism sustained by a chronic inflammatory state is another implicated factor, since high parathormone (PTH) values are frequent in Nutrients 2017, 9, 98; doi:10.3390/nu9020098 www.mdpi.com/journal/nutrients
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