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Found 14 results

  1. Celiac.com 08/28/2018 - There have been a number of studies that tried to estimate risk levels for celiac disease in patients with osteoporosis, but the data has been highly variable and inconclusive. To address this, a team of researchers recently set out to investigate rates of celiac disease among individuals with osteoporosis. The research team included M. Laszkowska, S. Mahadev, J. Sundström, B. Lebwohl, P. H. R. Green, K. Michaelsson, and J. F. Ludvigsson. They are variously affiliated with the Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA, the Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University in Uppsala, Sweden, the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet in Stockholm, Sweden, the Department of Paediatrics, Örebro University Hospital in Örebro, Sweden, and with the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham in Nottingham, UK. The team conducted a systematic review of articles that appeared in PubMed, Medline or EMBASE through May 2017 to find studies on rates of celiac disease in patients with osteoporosis. Search terms included “coeliac disease” combined with “fractures”, “bone disease”, “bone density”, “densitometry”, “osteoporos*”, “osteomal*”, “osteodys” or “dexa” or “dxa” or “skelet”. Non‐English papers with English‐language abstracts were included. To confirm their data, the team used fixed‐effects inverse variance‐weighted models, and tested heterogeneity through both subgroup analysis and meta‐regression. They found a total of eight relevant studies, containing data from 3,188 people with osteoporosis. From this group, the team found 59 individuals, or just under 2%, with celiac disease. A weighted pooled analysis showed biopsy‐confirmed celiac disease in 1.6% of osteoporosis patients. The team found moderate heterogeneity (I2 = 40.1%), which was influenced by the underlying celiac disease rates in the general population. After adding four studies covering a total of 814 people with celiac disease, based on positive tissue transglutaminase or endomysial antibodies, the pooled rate was comparable (1.6%; 95% CI = 1.2%‐2.0%). About 1.6% of people with osteoporosis have biopsy‐verified celiac disease. That’s about the same rate as the general population. Based on this data, the team sees no need to routinely screen osteoporosis patients for celiac disease, contrary to current guidelines. They suggest additional studies to assess the benefits and desirability of such screening programs. So, it looks like there’s no reason for people with osteoporosis, or their doctors, to be concerned about celiac disease unless patients shows some physical symptoms or signs. Read more in: Alimentary Pharmacology & Therapeutics
  2. Celiac.com 05/04/2018 - It has been recognized for several decades that both children and adults with celiac disease have a significantly increased frequency of osteoporosis and increased risk of fractures as compared to the age-matched non-celiac healthy individuals. Based on published data the prevalence of osteoporosis among celiac patients varies from as low as 4% to as high as 70%. The data from our clinic indicate that prevalence of osteoporosis among adults with gluten intolerance and celiac disease is in the vicinity of 30-40%. Characteristics and causes of osteoporosis Osteoporosis is a bone disease characterized by the reduced bone mineral density and impaired bone architecture that leads to an increased risk of fracture. The three main mechanisms by which osteoporosis develop include an inadequate peak bone mass, excessive bone resorption and inadequate formation of new bone during remodeling. At a given age, bone mass results from the amount of bone acquired during growth (the peak bone mass) minus the acquired bone loss due to variety of reasons including age-related processes, malabsorption syndromes, chronic steroid use etc. The rate and magnitude of bone mass gain during the pubertal years may markedly differ from one individual to another. It has been demonstrated that pediatric onset of celiac disease and poor compliance with gluten-free diet during childhood do significantly reduce peak bone mass. One of the main causes of osteoporosis is an alteration in bone remodeling due to imbalance between bone formation and resorption, with a predominance of resorption resulting in a reduction in bone mass and increased risk of fractures. Formation of the new bone is facilitated by specialized cells, osteoblasts, which actively synthesize bone matrix. Bone resorption is mediated by other specialized cells, osteoclasts. One of the main regulators of bone remodeling is the RANK/RANKL/OPG system. During bone remodeling, bone marrow cells and osteoblasts produce RANKL(receptor activator for nuclear factor kB ligand), which bonds with a transmembrane receptor of the osteoclast precursor, RANK(receptor activator of nuclear factor kB), causing their differentiation and activation. Osteoprotegerin (OPG) binds to RANKL before it has an opportunity to bind to RANK, and hence suppresses its ability to increase bone resorption. Normal bone remodeling is based on the permanent renovation of the skeleton and consists of an initial phase of bone resorption followed by a phase of formation, both of which are regulated by general (endocrine) factors and local (paracrine) factors. The main endocrine factors include parathyroid hormone [PTH] and vitamin D as well as estrogens and, to a lesser extent, testosterone, thyroid hormones, growth hormone and leptin. Local factors include various cytokines (IL-1, IL-6 and TNF-a playing a role) key growth factors that regulate the process. There are several well-characterized risk factors which contribute to the development of osteoporosis in celiac patients. These include: 1. Malabsorption of vitamin D and secondary hyperparathyroidism Villous atrophy in celiac patients reduces the active absorption surface and induces steatorrhea (exces fat in feces), which has a chelating effect on calcium and vitamin D, making their absorption difficult. This reduces levels of the vitamin D transporting protein (calbindin and calciumbinding protein) and increases PTH synthesis which, in turn, lead to increased bone resorption causing osteoporosis. 2. Malabsorption of vitamin K Malabsorption of fat soluble vitamins including vitamin K is a common finding in celiac patients. Three vitamin-K dependent proteins have been isolated in the bone: osteocalcin, matrix Gla protein (MGP), and protein S. Osteocalcin is a protein synthesized by osteoblasts. The synthesis of osteocalcin by osteoblasts is regulated by the active form of vitamin D—1,25-dihydroxy-cholecalciferol. The mineral-binding capacity of osteocalcin requires vitamin K-dependent gamma-carboxylation of three glutamic acid residues. MGP has been found in bone, cartilage, and soft tissue, including blood vessels. The results of animal studies suggest MGP facilitates normal bone growth and development. The vitamin K-dependent anticoagulant protein S is also synthesized by osteoblasts, but its role in bone metabolism is unclear. Children with inherited protein S deficiency suffer complications related to increased blood clotting as well as decreased bone density. The data on the role of vitamin K in osteoporosis came from the clinical observations indicating that a chronic use of vitamin K antagonists such as warfarin increases risk of vertebral and rib fractures. Accordingly, vitamin K supplementation significantly lowers risk of vertebral and hip fractures. 3. Magnesium deficiency Magnesium deficiency may be an additional risk factor for celiac-associated osteoporosis. This may be due to the fact that magnesium deficiency alters calcium metabolism and the hormones that regulate calcium. Several human studies have suggested that magnesium supplementation may improve bone mineral density. Magnesium deficiency is easily detected with laboratory tests (eg, low serum magnesium, low serum calcium, resistance to vitamin D) or clinical symptoms (eg, muscle twitching, muscle cramps, high blood pressure, irregular heartbeat). Screening for magnesium deficiency should be routinely included in the screening of celiac patients with osteoporosis. 4. Chronic diarrhea and metabolic acidosis Chronic diarrhea in patients with celiac disease results in significant bicarbonate losses and development of metabolic acidosis. Bone is a major site for the extracellular buffering of the retained acid. Therefore, one of the main compensatory mechanisms maintaining a stable serum bicarbonate level in the face of an uncorrected metabolic acidosis is the dissolution of bone buffers and net efflux of calcium from bone. Bicarbonate supplementation in patients with metabolic acidosis decreases urinary calcium, phosphorus and hydroxyproline wasting supporting the concept of negative effects of acidosis on bone health. 5. Hypogonadism Decline of estrogen production and activity is one of the main events in the development of age-related osteoporosis. It is well known that estrogen deficiency is important in the pathogenesis of osteoporosis not only in women but also in men. Increase in bone mineral density in young men and declines in older men are related to circulating free estrogen, not testosterone. In general, patients with celiac disease are characterized by low levels of circulating estrogens which contributes to the development of premature osteoporosis. 6. Chronic use of Proton Pump Inhibitors Proton pump inhibitors (PPIs) are one of the most widely used classes of drugs. The commonly used PPIs include such drugs as Omeprazole (brand name: Prilosec), Lansoprazole (brand name: Prevacid), Dexlansoprazole (brand names: Kapidex, Dexilant), Esomeprazole (brand name: Nexium), Pantoprazole (brand name: Protonix) and Rabeprazole (brand name: AcipHex). Chronic use of PPIs for gastroesophageal reflux disease and other related conditions has been associated with impaired calcium and magnesium absorption and increased risk of vertebral and nonvertebral fractures. 7. Chronic use of Selective Serotonin Reuptake Inhibitors Selective Serotonin Reuptake Inhibitors (SSRIs) are frequently used in celiac patients for treatment of depressive disorders. The commonly used SSRIs include such drugs as Citalopram (brand name: Celexa), Escitalopram (brand name: Lexapro), fluoxetine (brand name: Prozac), fluvoxamine (brand name: Luvox), Paroxetine (brand name: Paxil) and Sertraline (brand name: Zoloft). It has been demonstrated that SSRIs increase extracellular 5-HT (5-Hydroxytryptophan) levels that have deleterious skeletal effects. The skeletal serotonergic system consists of 5-HT receptors and the 5-HT transporter (5-HTT) in osteoblasts and osteocytes. 5-HTT is a transmembrane protein targeted by SSRIs. 5-HT restrains osteoblastic activity, thus leading to bone loss. 8. Autoimmune mechanisms Autoimmune mechanisms have been long suspected as risk factors contributing to development of osteoporosis in celiac patients. Near a decade ago, it was demonstrated that sera from celiac patients with osteoporosis contains significantly high titers of antibodies against bones as compared to non-celiac osteoporotic patients. The immunostaining was localized in areas where an active mineralization process occurred and was similar to the distribution of the native bone tissue transglutaminase. Recently, it has been described that a subset of patients with celiac disease has autoantibodies to osteoprotegerin, which block the inhibitory effect of osteoprotegerin on signaling by the receptor activator of nuclear factor (NF)-kappaB (RANK), and are associated with severe osteoporosis and high bone turnover. 9. Chronic inflammation Chronic inflammatory diseases, including celiac disease, are associated with overproduction of proinflammatory cytokines such as TNF-a, interleukin(IL)-1, IL-6, IL-11, IL-15 and IL-17 among others which activate osteoclasts and accelerate bone resorption leading to osteoporosis. In conclusion, osteoporosis associated with celiac disease is not a coincidental problem. It is a consequence of disease-specific (autoantibodies to osteoprotegerin), disease-nonspecific (malabsorption of vitamin D, K and magnesium, hypogonadism, chronic inflammation, chronic diarrhea and metabolic acidosis) and jatrogenic (overuse of PPIs and SSRIs) events accelerating resorptive processes in the skeleton. Correction of the aforementioned risk factors in celiac patients can reverse the development of osteoporosis and reduce the risk of osteoporosis-associated fractures. Bibliography: Bab I, Yirmiya R. Depression, selective serotonin reuptake inhibitors, and osteoporosis. Curr Osteoporos Rep. 2010 Dec;8(4):185-91. Bianchi ML. Inflammatory bowel diseases, celiac disease, and bone. Arch Biochem Biophys. 2010 Nov 1;503(1):54-65. Ito T, Jensen RT. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep. 2010 Dec;12(6):448-57. Katz S, Weinerman S. Osteoporosis and gastrointestinal disease. Gastroenterol Hepatol (N Y). 2010 Aug;6(8):506-17. Riches PL, McRorie E, Fraser WD, Determann C, van't Hof R, Ralston SH. Osteoporosis associated with neutralizing autoantibodies against osteoprotegerin. N Engl J Med. 2009 Oct 8;361(15):1459-65. Stazi AV, Trecca A, Trinti B. Osteoporosis in celiac disease and in endocrine and reproductive disorders. World J Gastroenterol. 2008 Jan 28;14(4):498-505. Sugai E, Cherñavsky A, Pedreira S, Smecuol E, Vazquez H, Niveloni S, Mazure R, Mauriro E, Rabinovich GA, Bai JC. Bone-specific antibodies in sera from patients with celiac disease: characterization and implications in osteoporosis. J Clin Immunol. 2002 Nov;22(6):353-62. Turner J, Pellerin G, Mager D. Prevalence of metabolic bone disease in children with celiac disease is independent of symptoms at diagnosis. J Pediatr Gastroenterol Nutr. 2009 Nov;49(5):589-93. Vasquez H, Mazure R, Gonzalez D, Flores D, Pedreira S, Niveloni S, Smecuol E, Mauriño E, Bai JC. Risk of fractures in celiac disease patients: a cross-sectional, case-control study. Am J Gastroenterol. 2000 Jan;95(1):183-9.
  3. Celiac.com 05/01/2018 - Celiac disease is marked by a variety of intestinal and extra-intestinal symptoms. One of the most common and best described expressions of celiac disease outside the gut is the presence of osteopenia and osteoporosis, which make for a higher fracture risk. A team of researchers recently set out to see if a gluten-free diet (GFD) improves bone mineralization. The research team included MB Zanchetta, AF Costa, V Longobardi, R Mazure, F Silveira, MP Temprano, H Vázquez, C Bogado, SI Niveloni, E Smecuol, ML Moreno, A González, E Mauriño, JR Zanchetta, and JC Bai. They are variously associated with the Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina; Research Institute, Universidad del Salvador, Buenos Aires, Argentina; the Department of Medicine, Dr C. Bonorino Udaondo Gastroenterología Hospital, Buenos Aires, Argentina; and with Consejo de Investigaciones en Salud, Health Ministry, Buenos Aires City Government, Buenos Aires, Argentina. These researchers previously identified a significant deterioration of bone microarchitecture in premenopausal women with newly diagnosed celiac disease using high‐resolution peripheral quantitative computed tomography (HRpQCT). In that study, the team also compared 1‐year results with those of a control group of healthy premenopausal women of similar age and BMI in order to assess whether the micro-architectural parameters of treated celiac patients had reached the values expected for their age. While that study showed that a year on a gluten-free diet had improved most of the women’s bone parameters, it also showed that those parameters continued to be significantly lower than those of healthy control subjects. In a recent paper, the team describes the results of their study that offers data to show improvements bone mineralization microarchitecture in celiac patients after three years on a gluten-free diet. Source: Clin Gastroenterol Hepatol. 2017 Oct 6. pii: S1542-3565(17)31200-4. doi: 10.1016/j.cgh.2017.09.054.
  4. Hi everyone, Due to poor bone health and high blood work, I am suspected to have Celiac's (a few more weeks and I will be back in the States to complete testing!). Anyway, I'm wondering if anyone had success stories about regaining bone density? My nephrologist says this will happen, and I trust her, but I would like to hear what anyone here did that helped or any sort of recommendations.
  5. Based on the information below, can anyone explain a 2.8% loss of bone density at the Fermoral Neck and 6.6% gain at the Lumber Spine after 2 years? I have Celiac and I'm stunned by the opposite! Treatment: Alendronate, 70 mg/week between April 25, 2013 to May 3, 2014. Ended due to stomach pain. Project Healthy Bones Class: Feb. 24, 2014 to April 20, 2015. We focus on posture, balance, strength and flexibility. Supplements: Calcium and Vit. D, daily. Bone Density Results T- Values Site March, 2013 April, 2015 Lumber Spine -2.7 -2.2 L1-L4, Dx osteoporosis osteopenia Density, g/cm2 0.797 0.850 Change, % ------------ +6.6 ------------------------------------------------------------------------------------------------ Left Hip -1.7 -1.7 Dx osteopenia osteopenia Density, g/cm2 0.773 0.776 Change, % ---------- +0.4 ------------------------------------------------------------------------------------------------ Femoral Neck -2.3 -2.5 Dx osteopenia osteoporosis Density, g/cm2 0.612 0.595 Change, % ----------- -2.8 -------------------------------------------------------------------------------------------- Thanks!
  6. I was here a few years back when I was trying to get testing for my daughter and you all were very helpful. Especially Irish Heart and a few others and I am still very grateful for their help. The GI did a gene test to rule out Celiac because of her GI issues with a negative Celiac blood panel. She does not carry the DQ2 or DQ8 genes. She was diagnosed as Non-Celiac Gluten Intolerance after we removed gluten even though the GI said there was no reason to go gluten-free. The transformation when she went gluten-free was simply amazing and the GI was shocked so she gave her that diagnosis. However, she cheats now and then because she isn't Celiac (we get to suffer with her bad moods because she feels lousy). I have a son who has been having GI issues and frequent non-traumatic fractures (6 in arm and 1 in his heel). His Celiac blood work was negative (full panel) but his DEXA came back as 3 STD below normal which is Osteoporosis. He is low in Vit D but not critcally and all other blood work seems fine. He is being tested for Osteogenesis Imperfecta Type V (types I-IV were ruled out by gene testing). I have a feeling this will come back negative. If that test comes back as negative, I want the GI to do an EGD (without gene testing) because one of the clinical reasons to do an EGD when a Celiac blood panel is negative, is unexplained osteoporosis. This will be a battle since the GIs at Children's (where we have to go for insurance reasons) really rely on the blood panels (they do run a full blood panel). My question is this: is there anyone on this forum that had a similar situation with their child? I would love to be able to give the GI some examples of kids with negative blood work but diagnosed osteoporosis and then had positive biopsy for celiac disease. Shooting for the moon, I am sure. We had planned to make my son gluten-free in Janaury regardless but now that he has been testing negative for Osteogenesis Imperfecta, I want to get that EGD to help rule out Celiac first. Thank you in advance for your help.
  7. My orthopedist is a very patient man . I saw him last summer he says full knee replacement I say no way, he says come back in 3 months . I go back in three months , he says full knee replacement this the only thing that will work , I say no way, he says come back in 3 months . I cancel that appt ( bad me lol ) but I finally go back to see him last Thursday . He puts up the x-ray from 6 months ago and the one I had Thursday side by side , he and I look at them then he turns and looks at me and says "well??? " Did I monition he is a very patient man . The deterioration of the knee is very obvious to even me I say ( a bunch of 4 letter words ,,under my breath of course ,lol) looks like I need to wrestle with my insurance co . One full knee replacement coming up I have osteoarthritis & osteoporosis . The midiscus is gone and it is bone on bone .The pain is off the scale I made the mistake of looking up what / how they do a full knee replacement This surgery scares me Being in the hosp ( doc says 4 - 6 days) dealing with all that entails is just plain overwhelming Then the weeks of rehab / recovery time Has anyone had this type of surgery ? how did you make out? are you glad you did it?
  8. Hi all, I was diagnosed with celiac and have been completely gluten free for 2 years. At that time I had a dexa scan and was diagnosed with osteopenia. I've been eating healthy foods and plenty of calcium for the past 2 years, but my repeat dexa scan just showed my numbers falling into osteoporosis in my spine. (Went from -2.3 two years ago to -2.8 now.) I'm 55, went through menopause at the average age, and am otherwise in pretty good physical shape. My doctor put me on bisphosphonates, took away my running and other high-impact or bending/twisting activities. I'm now taking in even more calcium (and trying to juggle it with my iron pill), walking and beginning strength training. From your experience, there a realistic chance of my spine healing to some extent? My score went downhill even though I've been gluten free (and repeat blood tests have confirmed I'm not getting into any unintentional gluten). Maybe it just takes that much time for my gut to heal so I can start absorbing calcium again--or is it too late? I could tell you all how hard it is to deal with this on top of the problems and isolation of celiac, but you're all walking the same road and understand.
  9. Celiac.com 06/08/2007 - In the first study, doctors Ibrahim S. Alghafeer, and Leonard H. Sigal conducted a routine gastroenterology follow-up of 200 adult celiac patients. Arthritis was present in 52 of 200 patients, or 26%. The arthritis was peripheral in 19 patients, Axial in 15 patients, and an overlap of the two in 18 patients. The doctors found that joint disease was much less common in those patients who were following a gluten-free diet (1). A related study by Usai, et al found that 63% of patients with celiac disease show axial joint inflammation (2). In that study, doctors conducted bone scintigraphy using 99m Tc methylene diphosphonate. 14 of these patients (65%) signs compatible with sacroiliitis. 11 of the 14 suffered from low back pain. In five of the 11 patients with low back pain, scintigraphy was negative. Sacroiliac radiographs were conducted on 4 of those 5 patients, and all of them were shown to have bilateral sacroiliitis. One patient had rheumatoid arthritis, but all patients in the studied showed negative HLA-B27 results. Rheumatoid Symptoms Less Common in Celiacs on Gluten-free Diet In patients with gluten enteropathy, symptoms of arthritis and other rheumatic complaints are common, and the associated clinical abnormalities routinely show improvement on a gluten-free diet. (3,4,5) In 9 of 74 patients with spondyloarthropathies, results show increased level of antigliadin antibodies, with 1 patient showing elevated antiendomysium antibodies and biopsy proven celiac disease (6). These results show that antiendomysial antibody testing is recommended as a screening tool in patients with suspected gluten enteropathy. Another study found that 3.3% of sprue patients had Sjogrens syndrome (7). 55 celiac patients who were tested for serial bone density showed osteoporosis in 50% of men and 47% of women. These findings confirm that celiac disease was an independent risk factor for osteoporosis (8). Bulletin on the Rheumatic Diseases, Volume 51, Number 2. Usai P. Adult celiac disease is frequently associated with sacroiliitis. Dig Dis Sci 1995;40:1906-8 Lubrano E, Ciacci C, Ames PR, et al. The arthritis of celiac disease: prevalence and pattern in 200 adult patients. Br J Rheumatol 1996;35:1314-8. Usai P. Adult celiac disease is frequently associated with sacroiliitis. Dig Dis Sci 1995;40:1906-8. Bagnato gluten-free, Quattrocchi E, Gulli S, et al. Unusual polyarthritis as a unique clinical manifestation of celiac disease. Rheumatol Int 2000;20:29-30. Borg AA, Dawes PT, Swan CH, Hothersall TE. Persistent monoarthritis and occult celiac disease. Postgrad Med J 1994;70:51-3. Collin P, Korpela M, Hallstrom O, et al. Rheumatic complaints as a presenting symptom in patients with celiac disease. Scan J Rheumatol 1992;21:20-3. Kallilorm R, Uibo O, Uibo R. Clin Rheumatol 2000;19:118-22. health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
  10. Celiac.com 07/01/2011 - People with celiac disease, who otherwise have no risk for osteoporosis, face a risk of developing progressive bone loss that is more than four times higher than the general population. This according to a study by the researchers from the Lancaster University School of Health and Medicine in the UK. In the latest study, the team took bone mass density readings of participants' skeletal health using dual-energy x-ray absorptiometry scans. They did this for more than 1,000 adults with celiac disease. The results showed that the lumbar vertebrae of individuals with celiac disease showed significantly lower bone density than those of healthy individuals. The team announced their findings at the European League Against Rheumatism's 2011 Annual Congress. No subject in the study had other risk factors for bone loss, and the team concluded that celiac disease increased the prospect of osteoporosis by a factor of four and a half, even among otherwise healthy adults. Because lumbar vertebrae sit at the base the spinal column, they take the most pressure, and thus, a more likely place for osteoporosis-related fractures. In the U.S., vertebral pressure fractures are the most common skeletal injury caused by progressive bone loss. Over a half a million vertebral pressure fractures occur each year, according to the National Osteoporosis Foundation. The UK study just the latest to show a connection between celiac disease and poor bone health. A 2010 report from Canada's University of Alberta that the average child with gluten allergies got less than half the amount of required vitamin K, as well as too little vitamin D. The research team suggests that dietary supplements may improve nutrition in children with celiac disease, and thus reduce the likelihood that they will develop osteoporosis. Source: endocrineweb.com
  11. Celiac.com 12/03/2009 - Clinicians recently described a case of severe osteoporosis with high bone turnover, in which they found neutralizing autoantibodies against osteoprotegerin to be present. They also report finding autoantibodies against osteoprotegerin in three additional patients with celiac disease. The clinical team reporting the findings was made up of Philip L. Riches, M.R.C.P., Euan McRorie, F.R.C.P., William D. Fraser, Ph.D., F.R.C.Path., Catherine Determann, B.Med.Sci., Rob van’t Hof, Ph.D., and Stuart H. Ralston, M.D. They are associated with the Rheumatic Diseases Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh (P.L.R., E.M., C.D., R.H., S.H.R.); and the Unit of Clinical Chemistry, School of Clinical Sciences, University of Liverpool, Liverpool (W.D.F.) — both in the United Kingdom. The adult patient presented severe, high-turnover osteoporosis associated with subclinical celiac disease and autoimmune hypothyroidism. The clinicians found circulating autoantibodies against osteoprotegerin. Autoantibodies against osteoprotegerin block the inhibitory effect of osteoprotegerin on signaling by the receptor activator of nuclear factor (NF)-κB (RANK). The patient's osteoporosis did not respond to celiac disease treatment of a gluten-free diet, but completely reversed with bisphosphonate therapy. Immunoglobulins purified from specimens of the patient’s serum abolished the inhibitory effect of osteoprotegerin on RANKL-induced NF-κB signaling in vitro, while those from the control serum did not, which indicates the presence of neutralizing autoantibodies against osteoprotegerin. The clinicians used immunoprecipitation assay for osteoprotegerin on non-fasting patient serum samples at several points during the course of his illness, as well as from 10 age-matched healthy male controls, 15 patients with celiac disease, and 14 patients with autoimmune hypothyroidism. They used bicinchoninic acid assay to measure protein content. Serum samples from the 10 healthy controls and the 14 patients with autoimmune hypothyroidism showed no evidence of circulating autoantibodies against osteoprotegerin, while the serum samples from 3 of the 15 patients (20%) with celiac disease did show antibodies. Autoantibodies against osteoprotegerin may be connected to the development of high-turnover osteoporosis, but whether autoantibodies against osteoprotegerin contribute to the pathogenesis of osteoporosis in celiac disease patients remains unknown. Source: N Engl J Med 2009;361:1459-65.
  12. Arch Intern Med. 2005;165:370-372, 393-399 Celiac.com 03/09/2005 - According to a new study by researchers at Washington University School of Medicine in St. Louis, Missouri, everyone with osteoporosis should also be screened for celiac disease. The study looked at 840 people—266 with osteoporosis and 574 without—who were screened for celiac disease using serum anti-tissue transglutaminase (tTG) and anti-endomysial (EMA) antibodies—those who tested positive for either were given a follow-up biopsy. The serological screening results indicated that 12 (4.5%) of the 266 osteoporotic patients were positive for celiac disease, while only six (1.0%) of the 574 non-osteoporotic patients tested positive. Out of the osteoporotic patients who were positive, 3.4% were confirmed by a biopsy, while only 0.2% of the non-osteoporotic patients were confirmed via biopsy (2 of the serological positive group refused a follow-up biopsy). In the group with both celiac disease and osteoporosis, the researchers found a direct correlation between the severity of both diseases, and the treatment of these patients via a gluten-free diet dramatically improved the symptoms of both diseases. According to the researchers: The prevalence of celiac disease among osteoporotic patients was much higher than among the non-osteoporotic population and high enough to justify a recommendation that all individuals with osteoporosis undergo serologic screening for celiac disease.
  13. Celiac.com 06/25/2003 - The following is an abstract of a recent study published in the June edition of the Journal of Association of Physicians of India by Dr. Y.A. Gokhale and colleagues from the Lokmanya Tilak Medical College and General Hospital, Mumbai (Bombay). The researchers conclude that symptomatic osteoporotic patients, especially those with associated anemia, who are younger than 55 years of age should be screened for celiac disease. Here is the abstract: Celiac Disease in Osteoporotic Indians YA Gokhale, PD Sawant, CM Chodankar, ND Desai, MV Patil, S Maroli, MN Patil, NK Hase J Assoc Physicians India June 2003;51:579-584 Abstract: Objective: The aim of the study was to identify the atypical celiac disease (celiac disease) in a cohort of symptomatic osteoporotic patients, younger than 55 years of age and 2) To study associated clinical and laboratory features and outcome with gluten-free diet. Material and Methods: We studied 33 patients (F:M =28:5),mean age 29 years (range 15-52 years) with osteoporosis (WHO diagnostic criteria, T-score less than -2.5 on DEXA scan) from January 2000-June 2002. Serological screening for celiac disease was done by detecting circulating IgA antibodies to tissue transglutaminase by ELISA. Patients with presence of antibodies to transglutaminase were subjected to biopsy from the 2nd part of the duodenum by upper GI endoscopy. The biopsies were reported independently by two pathologists who were blinded for the serology report. Measurement of mucosal thickness, crypts and villi were done with an ocular micrometer. Other parameters like complete hemogram, serum iron, total iron binding capacity (TIBC),calcium profile,25-OH-D, parathyroid hormone (PTH) were evaluated. Assessment of clinical and laboratory parameters was performed within 4-12 weeks of starting gluten-free diet (GFD). Results: Thirteen patients had circulating IgA antibodies to transglutaminase. Intestinal biopsies were performed on 11 patients and were consistent with the diagnosis of celiac disease (total villous atrophy -two, subtotal villous atrophy with crypt hyperplasia -nine). Patients with celiac disease had significant anemia when compared with non-celiac disease osteoporotic patients. Other important observations in these 11 patients were low serum calcium and phosphorus, low 25-OH-D, high PTH. Significant improvement in clinical and laboratory parameters was noted in all patients within 6-12 weeks of starting GFD. Conclusion: Symptomatic osteoporotic patients (younger than 55 years of age) especially with associated anemia should be investigated for celiac disease. Simple measures like omission of wheat from diet (GFD) lead to significant improvement in symptoms within weeks.
  14. The following was taken from a lecture given by Dr. Joseph Murray in October, 1996. It was published by the Sprue-Nik Press (Published by the Tri-County Celiac Sprue Support Group, a chapter of CSA/USA, Inc. serving southeastern Michigan) Volume 5, Number 9, December 1996. Dr. Joseph Murray, one of the leading USA physicians in the diagnosis of celiac disease (celiac disease) and dermatitis herpetiformis (DH). Dr. Murray (murray.joseph@mayo.edu) of the Mayo Clinic Rochester, MN, is a gastroenterologist who specializes in treating Celiac disease: Q: Can you touch on bone pain? A: The most common cause of severe bone pain with untreated celiac disease is osteomalacia, which is malformation of the bones due to lack of Vitamin D and calcium. It affects mostly the hips, and sometimes the shoulders and back. It usually gets better with specific treatment, which includes the gluten-free diet for celiacs and sometimes includes Vitamin D supplementation and other interventions. Another cause of bone pain is osteoporosis. It can often cause pain in the back, due to vertebrae which have become shortened and have begun squeezing the nerves. This condition is very painful and is not going to get better; once the vertebrae have shortened they are not going to stretch back up to their original size. Muscle pain can also occur, due to Vitamin D deficiency. I have seen some leg pains as the initial presentation of celiac disease which cleared up with the gluten-free diet.
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