Sa1256 High-Resolution Peripheral Quantitative Computerized Tomography Demonstrates Characteristics of Bone Fragility in Active Celiac Disease Patients

Abstract

Backgrounds: Patients with active celiac disease (CD) are more likely to have osteoporosis and increased risk for bone fractures. Cole's fracture is the most common event in CD patients (54%). Assessment of patients' risk using bone mineral densitometry (BMD) is recommended by CD guidelines. However, BMD does not always represent a precise indicator of damage and a reliable predictor of bone fracture. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a new in vivo imaging technique for assessing 3D microstructure of cortical and trabecular bone and for giving inside to factors involved in bone fragility. To our knowledge, no studies have investigated microstructural quality of bones in CD patients. Aims: To determine the structure characteristics of peripheral bones in a consecutive cohort of adult pre-menopausal females with active CD assessed at the time of diagnosis by using HR-pQCT. Methods: We prospectively enrolled 30 consecutive female patients with newly diagnosed CD. Parameters of patients were compared with 30 healthy, age-matched females with normal BMD measurements (lumbar spine, femoral neck and ultradistal radius). HR-pQCT bone volumetric and structural measurements were determined at the ultradistal non-dominant radius and tibia. Results: CD patients and healthy controls were comparable in terms of age, height, weight and body mass index (pNS). Lumbar spine, femoral neck and ultradistal radius BMD of CD patients were significantly lower than those values determined for healthy controls (p,0.01; p,0.04, p,0.001; respectively). However, while mean lumbar spine and femoral neck BMD values for CD patients remained in the normal range, ultradistal radius BMD mean z-score value for patients (-1.9±1.2) was borderline the lower end of the range expected for age. Structural damage in patients measured by using HR-pQCT was considerably higher in the ultradistal radius compared with tibia. Compared with controls, CD patients were significantly affected in the total volumetric density (p,0.006), trabecular density (p,0.001), bone volume/trabecular volume ratio (p,0.001), number of trabecules/mm (p,0.001) and trabecular thickness (p,0.004). Cortical bone was not significantly affected in any of the areas assessed. Conclusions: HR-pQCT was able to identify significant bone trabecular deterioration that may be responsible for the increased fragility and fracture prevalence in active CD. This affected quality of the trabecular bone was characterized by a lower number and a reduced thickness of trabecules, both producing a lower trabecular density. These changes were more pronounced in the ultradistal radius. Notably, cortical bone was preserved. Whether these women are able to recover trabecular bone density and structure after gluten-free diet is not known and will be assess in future results of this longitudinal study.