Celiac disease and bone

Abstract

Celiac disease (CD) is an autoimmune disorder characterized by small intestinal inflammation triggered by gluten ingestion in genetically-predisposed individuals. A frequent extra-intestinal manifestation of CD is metabolic bone disease which contributes to an increased risk of fracture. The mechanisms underlying bone disease in CD remain incompletely understood, but multiple processes have been proposed including (1) malabsorption of calcium and vitamin D leading to secondary hyperparathyroidism and increased skeletal resorption, (2) pro-inflammatory cytokines altering the osteoprotegerin and receptor activator of nuclear kappa-B ligand ratio favoring osteoclastogenesis, (3) hypogonadism, and (4) low weight and malnutrition. Most studies show reduced bone mineral density in patients with CD. Bone microarchitecture is also deteriorated leading to reduced whole bone stiffness. Many, but not all investigations, have shown an increased risk of fracture associated with CD. The main stay of therapy for CD is maintaining a gluten-free diet. Improvement in bone mineral density with adherence to a gluten-free diet has been well-established. Bone mineral density remains lower, however, compared to controls and increased fracture risk can persist. There is no consensus on the timing of dual-energy x-ray absorptiometry for bone mineral density assessment in patients with CD. Routine screening for CD in patients with osteoporosis is not recommended. Little data are available on the use or efficacy of prescription osteoporosis therapeutics in patients with CD. Studies are needed to develop standardized guidelines for screening and treatment of metabolic bone disease in patients with CD to identify those who may need early intervention with prescription osteoporosis therapy.

Associations between Celiac Disease, Extra-Gastrointestinal Manifestations, and Gluten-Free Diet: A Narrative Overview

“…Bone manifestations such as decreased bone density, bone pain and fracture, osteopenia, and osteoporosis are common in CeD patients ( Figure 2 ; Table 1 ). The underlying mechanisms remain incompletely understood, although several mechanisms, such as the malabsorption of calcium and vitamin D and the secretion of pro-inflammatory cytokines, have been suggested [ 41 ]. Decreased bone mineral density (BMD) has been frequently diagnosed in both children and adults with active CeD.…”

The relationship of endocrine and gastroenterological pathology: dietary fiber as a mechanism of management

“…Помимо этого, необходимо адекватное восполнение дефицита микро-и макронутриентов, баланс которых в организме нарушен по причине мальабсорбции. Назначение пациентам с остеопорозом препаратов кальция и витамина D, помимо классической анаболической и антирезорбтивной терапии по показаниям, является неотъемлемой частью терапии остеопороза, особенно в случае пациентов с целиакией [31]. Несмотря на то, что единственным методом лечения целиакии является пол-ное исключение из рациона глютена, в настоящее время активно изучаются способы дополнительной коррекции данного состояния.…”

A importância da nutrição integrativa em pacientes com doenças autoimunes

“…Em casos mais extremos podendo chegar a hipocalcemia e hipovitaminose D levando os osteoblastos a remodelação óssea como consequência de hiperparatireoidismo, contudo, torna-se o acompanhamento do paciente tão importante uma vez que, mesmo retirando o glúten da dieta, e melhorando o remodelamento ósseo, a absorção dos nutrientes continuam comprometidas, em menor pelo dano já causado todavia em menor número (Kondapalli et al, 2022).…”