Bone Metabolism and Osteoporosis in Adult CeliacDisease
- Autores: Alvaro García Manzanares, Alfredo J. Lucendo
- Localización: Celiac Disease and Non-Celiac Gluten Sensitvity / coord. por Amado Salvador Peña; Luis Rodrigo (ed. lit.), 2014, ISBN 978-84-942118-2-9, págs. 327-346
- Idioma: inglés
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Resumen
Celiac disease (CD) afects around 1-2% of the world populaton. Many current CD patents livewith their symptoms for years before diagnosis, and are therefore exposed to the consequencesof the disease, including an impaired bone mineralizaton. In this chapter we provide an updateddiscussion on the relatonship between low bone mineral density (BMD), osteopenia andosteoporosis, and celiac disease. Review of the literature shows, low BMD afects up to 75% ofpatents with celiac disease and 40% of those diagnosed during adulthood. It can be found at anyage, independently of positve serological markers and presence of digestve symptoms,contributng to deterioraton in the quality of life. The prevalence of CD among osteoporotcpatents is also signifcantly increased. Two theories try to explain the origin of low BMD:Micronutrients malabsorpton (including calcium and vitamin D) determined by villous atrophyhas been related to secondary hyperparathyroidism and incapacity to achieve the potental bonemass peak; chronic infammaton was also related with RANKL secreton, osteoclasts actvatonand increased bone reabsorpton. As a consequence, CD patents have a risk for bone fracturesthat exceeds 40% that of matched non-afected populaton. Treatment of low BMD in CDcomprises gluten-free diet, calcium and vitamin D supplementaton, and biphosphonates,although its efects on CD have not been specifcally assessed. It can be concluded that a relevantproporton of CD patents present a low BMD and a variable increase in the risk of bonefractures. Epidemiological changes in CD make bone density scans more relevant for adultceliacs.
