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Most Celiac-related Bone Impairment Improves After One Year On Gluten-Free Diet


Image: CC--Mark B. Schlemmer

Celiac.com 12/19/2016 - Research conducted with high-resolution peripheral quantitative computed tomography (HRpQCT) has documented substantial bone micro-architecture in premenopausal women with newly diagnosed celiac disease.

A team of researchers recently set out to assess changes in bone micro-architecture after 1 year on a gluten-free diet in a cohort of pre-menopausal women. The research team included MB Zanchetta, V Longobardi, F Costa, G Longarini, RM Mazure, ML Moreno, H Vázquez, F Silveira, S Niveloni, E Smecuol, Temprano M de la Paz, F Massari, E Sugai, A González, EC Mauriño, C Bogado, JR Zanchetta, and JC Bai.

They are variously affiliated with the Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina; the Sección Intestino Delgado, Departamento de Medicina at the Hospital de Gastroenterología "Dr. C. Bonorino Udaondo” in Buenos Aires, Argentina; and with the Cátedra de Gastroenterología Facultad de Medicina and the Cátedra de Osteología y Metabolismo Mineral at the Universidad del Salvador in Buenos Aires, Argentina.

Their team prospectively enrolled 31 consecutive females upon celiac diagnosis, and reassessed 26 of them after 1 year of gluten-free diet. All patients received HRpQCT scans of distal radius and tibia, areal BMD by DXA, and bone-specific parameters and celiac serology both times. The team then compared 1-year results against data from a control group of healthy pre-menopausal women of similar age and BMI in order to assess whether the micro-architectural parameters of treated celiac patients matched values expected for their age.

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Compared with baseline, the trabecular compartment in the distal radius and tibia showed marked improvement of trabecular density, trabecular/bone volume fraction [BV/TV] [p < 0.0001], and trabecular thickness [p = 0.0004]. Trabecular number remained stable in both regions. Cortical density increased only in the tibia (p = 0.0004). Cortical thickness decreased significantly in both sites (radius: p = 0.03; tibia: p = 0.05). DXA increased in all regions (lumbar spine [LS], p = 0.01; femoral neck [FN], p = 0.009; ultradistal [UD] radius, p = 0.001).

Most parameters continued to be significantly lower than those of healthy controls. This prospective HRpQCT study showed that most trabecular parameters altered at celiac disease diagnosis improved significantly with a gluten-free diet, along with calcium and vitamin D supplementation. However, there were still significant differences with a control group of women of similar age and BMI.

The team plans a prospective follow-up, in which they expect to be able to assess whether bone micro-architecture matches levels expected for a given patient's age.

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