Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease

Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County, Minnesota

“…Physicians need to give attention to the early detection and treatment of celiac disease, as well as active detection and management of bone disease, secondary hyperparathy-roidism and vitamin D deficiency in celiac disease [17,18,55]. Celiac disease patients diagnosed and treated at a young age are more likely to return to normal bone density than those diagnosed and treated later in adulthood [56][57][58][59]. Given the general tendency for advancing age to increase fracture risk in both cases and controls, physicians should consider early measurement of bone mineral density in celiac patients, as well as measuring serum vitamin D levels with therapy including supplementation with calcium or vitamin D, as appropriate.…”

Altered bone metabolism in inflammatory disease: role for nutrition

“…Osteopenia and osteoporosis are recognised complications of IBD, and while there is some uncertainty about their exact prevalence, it is generally accepted that the prevalence of reduced BMD is increased in patients with IBD (5,25) . Given the variation in site, extent and severity of disease between patients with IBD, the variation of all these factors with time and associated drug therapy (especially steroids) it is not altogether surprising that results of studies of osteoporosis in IBD are less consistent than those in coeliac disease (4) . In a comprehensive systematic review of osteoporosis in IBD it is highlighted that the prevalence of severe demineralisation in patients with IBD depends on which evidence is considered; it has been reported to be as low as 2-16% (data from larger controlled studies) and as high as 18-42 % (from uncontrolled studies) (26) .…”

“…One review of the evidence suggests that > 75% of untreated adult patients with coeliac disease suffer from a loss of bone mass, and that coeliac disease should be considered one of the most frequent predisposing conditions to metabolic osteopathy (6) . While there are a number of relatively small studies that report variable estimates of excess fracture risk in patients with coeliac disease, data from two populationbased reports show a slight increase in fracture prevalence (for reviews, see Scott et al (4) , Corazza et al (6) and Bianchi & Bardella (20) ). Biochemical markers that reflect the processes of bone resorption and bone formation, and thus bone turnover, can be measured in blood and urine (21) .…”

“…Its treatment is the lifelong withdrawal of gluten from the diet. There is very good evidence for reduced BMD in patients with coeliac disease and this evidence base has been summarised elsewhere (4,6,20) . One review of the evidence suggests that > 75% of untreated adult patients with coeliac disease suffer from a loss of bone mass, and that coeliac disease should be considered one of the most frequent predisposing conditions to metabolic osteopathy (6) .…”

“…There is an increase in incidence rates of osteoporotic fractures with age, and the demographic changes and increasing life expectancy within many countries will have a huge impact on the number of fractures that can be expected to occur (1,3) . Osteoporosis risk is also increased in a number of diseases with an inflammatory component, such as inflammatory bowel disease (IBD) (4,5) , coeliac disease (4,6) and rheumatoid arthritis (7) . The bone loss associated with some of these diseases is a major risk factor for osteoporotic fractures of the spine, wrist and hip, which can have a deleterious effect on the quality of life of patients, especially for young patients who have a normal life expectancy.…”