Osteoporosis and Celiac Disease: is it useful to a new guideline?
Santa Maria del Prato Hospital, Feltre, Italy
- *Corresponding Author:
- Alessandro Geraci, MD, PhD.
Orthopedic and traumatology unit
Santa Maria del Prato Hospital
Via bagnolis sur ceze 3, Feltre, Italy
Received date: July 22, 2011; Accepted date: October 17, 2011; Published date: October 19, 2011
Citation: Geraci A (2011) Osteoporosis and celiac disease: is it useful to a new guideline? J Gastrointest Dig Syst 1:e103. doi: 10.4172/2161-069X.1000e103
Copyright: © Geraci A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Celiac disease (CD) is a permanent glutensensitive enteropathy characterised by reversible small-bowel mucosal atrophy in a genetically predisposed person, resulting from an inappropriate immune response to dietary gliadin, a component of wheat proteins. CD can have a varied clinical presentation, with most symptoms being attributed to malabsorption . CD has long been known to cause metabolic bone disease. Early reports focused mainly on the association with vitamin D deficiency and osteomalacia, but more recently attention has turned to Osteoporosis (OS) [2,3]. OS can be reliably detected by measurement of bone mineral density (BMD), which can be expressed as the number of standard deviation (SD) above or below either the mean BMD for young adults (T score) or the mean BMD for age matched controls (Z score). A BMD more than 2.5 SD below the mean for a young adult is generally taken to indicate OS . Stratification for fracture risk is possible using BMD. The risk increases roughly twofold for each SD decline in BMD below the population mean. The risk of low BMD seems to rise with increasing age at diagnosis, decreased body weight and in postmenopausal women . Low BMD can be detected even in children and adolescents with newly diagnosed CD . Furthermore, the need to consider CD as a pathogenetic factor in individuals presenting with OS has been emphasised; this particularly applies to those with clinical features of the disease and those who fail to respond to treatment for their OS. As the risk of sustaining an osteoporotic fracture is estimated to double with each standard deviation decrease in bone mineral density , various groups, including the British Society of Gastroenterology , have recommended that adult celiacs should have regular bone scans and if OS is detected prolonged treatment with hormone replacement therapy or bisphosphonates.