Терапевтический архив (Feb 2010)
Bone mineral density in patients with gluten-sensitivity celiac disease
Abstract
Aim. to determine the frequency of development of osteopenia/ostoporosis (OP), vitamin D deficiency, some population risk factors, and the effects of α-calcidol and calcitriol on bone mineral density (BMD) in patients with gluten-sensitivity celiac disease (GSCD). Subjects and methods. Densitometry of the lumbar vertebra and femoral neck (FN) was carried out in 47 patients with GSCD. Their sera were tested for 25OHD3, 1,25(OH)2D3, total alkaline phosphatase, calcium, phosphorus, parathyroid hormone (PTH), type 1 collagen type C-telopeptides (CrossLaps) and tumor necrosis factor-α (TNF-α), as well as urinary creatinine and calcium. Results. The T score below -1 was found in 37 (78.7%) of the patients. BMD reduced to the level of osteopenia in 51.1% of the patients; OP was detected in 27.7%. Lower BMD was noted in 19 (95%) of the 20 menopausal women and in 15 (68.2%) of the 22 females with preserved menstrual function (p = 0.047). The mean value of 25OHD3 was 47.8 ± 5.0 in patients with OP patients and 85.6 ± 7.1 ng/l in those with normal BMD (p < 0.001). The latter had no decreased level of vitamin D, suggesting its deficiency, but 11 (30%) osteopenic patients were found to have vitamin D deficiency (25OHD3 < 30 ng/l). Impaired calcitriol synthesis (69.9 ± 24.0 ng/l) was observed only in patients with OP; the level of calcitriol was 85.6 ± 31.2 ng/ml in those with normal BMD. Decreased BMD was accompanied by elevated PTH levels in 25 (67%) patients with GSCD. There were increases in the bone resorption marker CrossLaps and in the level of TNF-α in 28 (76%) and 8 (22%) osteopenic patients, respectively. A more significant BMD reduction was seen in the presence of antibodies to gliadin and tissue transglutaminase. A significant correlation was found between the titer of immunoglobulin A antibodies to gliadin and TNF-α (ρ = -0.57; p = 0.035), CrossLaps (ρ = -0.58; p = 0.035), T scores in the vertebral column and FN (ρ = -0.62; p = 0.030) and (ρ = -0.37; p = 0.06), respectively. Conclusion. The risk for OP in patients with GSCD is affected by menopause and the clinical features of the disease: secondary hyperparathyroidism due to impaired calcium and vitamin D absorption, by the activity of immunological inflammation and the compliance with a gluten-free diet. The immunological activity of inflammation is closely related to the activation of bone resorption and enhances a BMT reduction in patients with celiac disease. The use of vitamin D preparations (α-calcidol and calcitriol) in combination with calcium salts lowers BMD in patients with celiac disease just within the first 6 months.
