Bone Mass and Mineral Metabolism Alterations in Adult Celiac Disease: Pathophysiology and Clinical Approach

Abstract

Osteoporosis affects many patients with celiac disease (CD), representing the consequence of calcium malabsorption and persistent activation of mucosal inflammation. A slight increase of fracture risk is evident in this condition, particularly in those with overt malabsorption and in postmenopausal state. The adoption of a correct gluten-free diet (GFD) improves bone derangement, but is not able to normalize bone mass in all the patients. Biomarkers effective in the prediction of bone response to gluten-free diet are not yet available and the indications of guidelines are still imperfect and debated. In this review, the pathophysiology of bone loss is correlated to clinical aspects, defining an alternative proposal of management for this condition.

Impact of a gluten-free diet on bone mineral density in celiac patients

“…Intestinal malabsorption could also lead to some deficits of other minerals (such as zinc, copper, etc.) and vitamins that affect normal bone metabolism (18). A decrease of IGF-I (insulin growth factor I) is observed in osteoporotic patients.…”

“…Also unabsorbed fatty acids bind calcium reducing its intestinal absorption (18). Low calcium levels trigger a compensatory increase in parathyroid hormone (PTH) responsible for bone reabsorption resulting in OP (18,19). Intestinal malabsorption could also lead to some deficits of other minerals (such as zinc, copper, etc.)…”

“…The first one is malabsorption of micronutrients due to villous atrophy (17). A negative calcium balance is partially due to this mechanism (17); another cause is the reduction of calcium intake due to secondary lactose intolerance (18). Also unabsorbed fatty acids bind calcium reducing its intestinal absorption (18).…”

“…A negative calcium balance is partially due to this mechanism (17); another cause is the reduction of calcium intake due to secondary lactose intolerance (18). Also unabsorbed fatty acids bind calcium reducing its intestinal absorption (18). Low calcium levels trigger a compensatory increase in parathyroid hormone (PTH) responsible for bone reabsorption resulting in OP (18,19).…”

“…There is a debate in the literature about whether the gluten-free diet (GFD) may help in the restoration of bone mass; while some authors have found benefit (6)(7)(8), others deny it (9,10). A third group found out that bone mineral density values normalize only in children that follow a strict GFD (11).…”