Low Bone Mineral Density in Brazilian Patients at Diagnosis of Celiac Disease

Utiyama

et al. 2021

Arq. Gastroenterol.

BACKGROUND: Celiac disease (CD) is an autoimmune disease characterized by immune reaction mostly to wheat gluten. The diagnosis is based on clinical, serological and histological findings in patients ingesting gluten. Cases that the clinical profile indicates CD and the autoantibodies are negative bring so a dilemma for the professional, as the risk of missed the diagnosis or a delay at the same. OBJECTIVE: To show the importance of correct diagnosis of cases with seronegative celiac disease (SNCD). METHODS: Ten cases of SNCD Brazilian patients were retrospectively studied (2013 to 2019). Data of clinical complaints, autoantibodies, IgA serum levels, histological findings and HLA-DQ2/DQ-8 were compiled. Dual-X densitometry, delay at diagnosis, previous autoimmune diseases and family history of CD were also checked. RESULTS: All SNCD patients presented clinical symptoms of CD, with confirmed diagnosis by histological findings of the duodenal mucosa and HLA-DQ2 and/or HLA-DQ8 positivity. All patients had normal IgA levels and negative autoantibodies (IgA-anti-transglutaminase and anti-endomysial). Dual-X densitometry detected osteopenia in two women and osteoporosis in two males, all with low levels of vitamin D. Delay diagnostic ranged from 1 to 19 years. Familiar occurrence of CD was reported in 40% of the cases. After one year of gluten-free diet, eight patients refer improve of symptoms, while duodenal biopsies, done in five cases, showed histological improvement. CONCLUSION: Patients who demonstrate the clinical profile of celiac disease with negative serology and normal levels of IgA, especially those who have family members with celiac disease, should be submitted to duodenal biopsies to look for histological findings.

Section: Discussionsupporting

confidence: 91%

Seronegative Celiac Disease in Brazilian Patients: A Series of Cases

Utiyama

et al. 2021

Arq. Gastroenterol.

“…Osteopenia was observed in 41.5% of males and 75% of females even younger than 30 years old, however osteoporosis in males was more than females in this younger age goup (8.5% vs. 4.2%) but in age. 30–50 years old osteopenia and osteoporosis was more common in female and in age more than 50,Osteopenia was more common among males (66% vs. 33%), and osteoporosis was more common among females (20.6% vs. 16.6%) [36] (Table 1). Nawadays, prevalence of osteopenia and osteoporosis is more common in CD than unaffected population in the same age range [37].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of osteoporosis and osteopenia in men and premenopausal women with celiac disease: a systematic review

Ganji

Moghbeli

Sadeghi

et al. 2019

Nutr J

Background Celiac disease (CD) is known as a reason of metabolic osteopathy. Progression of non-invasive methods such as bone densitometry has shown that an important ratio of CD cases is faced with impaired bone mass and such cases are prone to bone fractures. Variety of low bone mineral density in CD is probably because of ignored confounding factors such as age, menopause, and drug. The aim of our study was to systematically review the osteoporosis and osteopenia incidences among premenopausal females and males with CD. Methods This systematic review was done based on preferred reporting items for systematic reviews (PRISMA) guidelines. PubMed and Scopus and Cochran databases were searched according to the relevant medical subject headings (MeSH) of CD and bone mineral density until 2018. Prevalence of osteopenia and osteoporosis were used as effect size for meta-analysis. Cochrane Q ( p < 0.05) and I 2 index were presented to reveal the heterogeneity. Results 54 eligible full text reviews were included and nineteen selected for data extraction. Eleven articles didn’t have our inclusion criteria and had ignored confounding factors like age and menopause, and we excluded; data extraction was done in eight studies. A total of 563 premenopausal women and men who were from, UK, Brazil, India, Hungary, and Poland were included. The pooled prevalence of osteoporosis was 14.4% [95%CI: 9–20.5%] (Cochrane Q = 7.889, p = 0.96, I 2 = 49.29%), and osteopenia was 39.6% [31.1–48.8%] (Cochrane Q = 14.24, p = 0.07, I 2 = 71.92%), respectively. Conclusion Our findings suggest that bone loss is more prevalent in celiac disease and can be associated with increased risk of fracture. However, but results are pooled prevalence and we need more case –control studies with more sample size and consideration of confounding factors.

“…In addition to IBD, other chronic diseases have been associated with osteoporosis, such as celiac disease, systemic lupus erythematosus (SLE), and cystic fibrosis. Silva et al 13 showed that 68.3% of the celiac patients at the time of diagnosis had low BMD, 47% had osteopenia, and 32% had osteoporosis. Studying patients with SLE, Bultink 14 described the occurrence of bone changes in 68% of them.…”

Section: Discussionmentioning

confidence: 99%

Alert for bone alterations and low serum concentrations of vitamin D in patients with intestinal inflammatory disease

Costa

Cavassani

et al. 2017

Rev. Assoc. Med. Bras.

Self Cite

Background: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are characterized by chronic inflammation of the intestine that can reduce the absorption of nutrients such as vitamin D and calcium. Objective: To investigate bone alterations and serum levels of vitamin D in patients with IBD. Method: This was a cross-sectional study based on a review of medical records of patients from a private office in Curitiba, PR, Brazil. Serum levels of vitamin D and bone densitometry were measured at diagnosis of IBD. A total of 105 patients were included; 38 (58.4%) with CD; 27 (41.6%) with UC and 40 with irritable bowel syndrome (IBS) as comparison group. Results: When compared to patients with UC, CD patients showed a higher prevalence of bone alterations, being 15.8% with osteoporosis and 36.8% with osteopenia. In UC, bone alterations occurred in 29.6% of cases, 3.7% with osteoporosis and 25.9% with osteopenia. As for vitamin D levels, among CD patients, 10.5% had vitamin deficiency, 65.8% insufficiency and 23.7% were sufficient. In UC, 7.4% of cases had deficiency, 74.1% insufficiency and 18.5% had sufficient serum levels of vitamin D. In the group with IBS, deficiency was observed in 17.5% of cases, insufficiency in 55% and sufficiency in 27.5% of them. There was no significant difference between groups. Conclusion: IBD patients have a high prevalence of bone changes, especially those with CD. Serum levels of vitamin D are below the recommended in all the evaluated groups.