Newly Diagnosed Celiac Disease and Bone Health in Young Adults: A Systematic Literature Review

Mosca, Caterina; Thorsteinsdottir, Fanney; Abrahamsen, Bo; Rumessen, Jüri Johannes; Händel, Mina Nicole

doi:10.1007/s00223-021-00938-w

Cited by 25 publications

(19 citation statements)

References 19 publications

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“…A comparative meta-analysis of 20995 patients with CeD and 97777 controls from eight studies published between 2000 and 2007, found that patients with CeD have a 43% higher risk for developing non-traumatic fracture compared with controls[ 61 ]. Also a recent study found that patients with newly diagnosed CeD have low bone marrow density and this improves after initiation of GFD[ 62 ].…”

Section: Probable Indications For Screening For Cedmentioning

confidence: 99%

Who to screen and how to screen for celiac disease

Singh¹,

Singh²,

Ahuja³

et al. 2022

WJG

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Celiac disease (CeD) is a chronic gluten-induced enteropathy with plethoric manifestations. The typical manifestations of CeD such as chronic diarrhea and malabsorption are widely recognized, however, many patients have atypical manifestations like iron deficiency anemia, idiopathic short stature, hypertransaminesemia or infertility, etc. These patients often present to the primary care physicians and/or non-gastrointestinal specialties. However, due to a lack of awareness among the healthcare professionals about the various atypical manifestations, many patients are not screened for CeD. In this review, we have summarized the available literature about the prevalence of CeD in various gastrointestinal (chronic diarrhea) and non-gastrointestinal conditions (iron deficiency anemia, short stature, cryptogenic hypertransaminesemia, cryptogenic cirrhosis or idiopathic ataxia etc. ) where the diagnosis of CeD should be con-sidered. In addition, we also discuss special scenarios where screening for CeD should be considered even in absence of symptoms such as patients with type 1 diabetes, Down’s syndrome, and first-degree relatives of patients with CeD. Further, we discuss the diagnostic performance and limitations of various screening tests for CeD such as IgA anti-tissue transglutaminase antibodies, anti-endomysial antibodies and anti-deamidated gliadin antibodies. Based on the current recommendations, we propose a diagnostic algorithm for patients with suspected CeD.

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Section: Probable Indications For Screening For Cedmentioning

confidence: 99%

Who to screen and how to screen for celiac disease

Singh¹,

Singh²,

Ahuja³

et al. 2022

WJG

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“…Symptomatic disease may be associated with more significant bone mineral loss. Traditional risk factors are not always present, so young people, those with normal BMI and males can all be affected 104,105 . Bone fracture risk is increased in coeliac disease 15,106,107 with the risk persisting with ongoing villous atrophy.…”

Section: Monitoring For Complicationsmentioning

confidence: 99%

Review article: Follow‐up of coeliac disease

Tye–Din

2022

Aliment Pharmacol Ther

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Coeliac disease is a lifelong immune-mediated enteropathy associated with important systemic manifestations. 1,2 A strict gluten-free diet (GFD) is the cornerstone of management but does not resolve the underlying immune cause of coeliac disease. 3 The GFD imparts a substantial treatment burden, 4 and many patients fail to achieve complete symptom or mucosal remission. As coeliac disease is associated with increased morbidity and modestly increased mortality, periodic medical follow-up is considered a crucial component of patient care [5][6][7][8] but this is compromised by the paucity of evidence to inform best-practice approaches. 9,10 As a result, real-world follow-up is often inconsistent or absent altogether. [11][12][13] For many chronic illnesses, such as type 1 diabetes, the importance of maintaining long-term follow-up to assess disease status, treatment efficacy and monitor for complications is well established in the medical community, however, for coeliac disease, this is typically not the case, even though the monitoring goals are the same. 5,6,7,8,14 For patients, the key goals of treatment are to resolve symptoms, reduce the risk of complications and achieve optimal quality of life, and for clinicians, disease remission also encompasses healing of the enteropathy. Effective models of care that leverage local medical and allied health expertise, ideally involving a gastroenterologist, dietitian and primary care provider, will support these goals but willThe Handling Editor for this article was Professor Peter Gibson, and it was accepted for publication after full peer-review.

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“…There is evidence to suggest that BMD increases during the one or two years up to 5 years of GFD, particularly in those younger than 40 years of age [ 26 , 27 , 77 , 79 ]. GFD benefits elderly patients with newly diagnosed CeD, with significant gains in BMD at the lumbar spine and femur in the first 12 months of treatment [ 78 , 80 ]. However, convincing evidence about achieving and maintaining normal bone mass is lacking.…”

Section: General Non-pharmacological Management Of Osteoporosis In Ad...mentioning

confidence: 99%

The Dietary and Non-Dietary Management of Osteoporosis in Adult-Onset Celiac Disease: Current Status and Practical Guidance

Al–Toma

Herman²,

Lems³

et al. 2022

Nutrients

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Impaired bone mineral density (BMD) is a frequent complication of adult-onset celiac disease (CeD). This is usually due to malabsorption of nutrients, changes in bone metabolism in association with inflammation, and to a lesser extent, decreased overall physical health and mobility. This review aims to highlight the current status concerning surveillance, prevention, and treatment strategies for bone disease in CeD. A practical guidance on these matters is suggested. The available published research on the prevention and treatment of decreased BMD in relation to CeD is scarce. In general, publications were based on expert opinions or extrapolation from studies on postmenopausal women or inflammatory bowel disease. Optimal dietary treatment and an adequate supply of calcium and vitamin D are the cornerstones for the reduction in fracture risk in patients with CeD. In adults with low BMD or fragility fractures, CeD needs to be considered and specifically approached. When osteoporosis is documented, start treatment with an antiresorptive agent; these agents are proven to result in a long-term reduction in fracture risk in high-risk individuals. However, there are some important differences between the management of male and female patients, particularly premenopausal women, that need to be addressed. In patients with persisting diarrhea and malabsorption, parenteral medications may be preferable. Future research specifically focusing on celiac disease and the associated disorders in bone mineralization is mandatory to provide evidence-based recommendations in this field.

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Newly Diagnosed Celiac Disease and Bone Health in Young Adults: A Systematic Literature Review

Cited by 25 publications

References 19 publications

Who to screen and how to screen for celiac disease

Who to screen and how to screen for celiac disease

Review article: Follow‐up of coeliac disease

The Dietary and Non-Dietary Management of Osteoporosis in Adult-Onset Celiac Disease: Current Status and Practical Guidance

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