Celiac disease – a frequent cause of „idiopathic osteoporosis“ in premenopausal and early postmenopausal women


Authors: Ľ. Kubincová 1;  J. Payer 2;  Z. Killinger 2;  I. Mačugová 3;  K. Beráková 4
Authors‘ workplace: Osteologická ambulancia Interného oddelenia, NsP Žilina, Slovenská republika, prednosta prim. MUDr. Vladimír Spišák 1;  V. interná klinika Lekárskej fakulty UK a FNsP Bratislava-Ružinov, Slovenská republika, prednosta prof. MUDr. Juraj Payer, CSc. 2;  Gastrocentrum NsP Žilina, Slovenská republika, prednosta prim. MUDr. Peter Haupt 3;  Patologicko-anatomické oddelenie NsP Čadca, Slovenská republika, prednostka prim. MUDr. Katarína Beráková 4
Published in: Vnitř Lék 2007; 53(12): 1296-1302
Category: Original Contributions

Overview

Introduction:
Celiac disease (CD) is an autoimmune disease with a wide variety of clinical symptoms. Osteopathy is its possible manifestation in adulthood.

Objective:
Verify the assumption, in view of contradictory literary data concerning serological screening for CD in osteoporosis, that the screened group could be women with idiopathic osteoporosis diagnosed in premenopause or within 5 years from its onset.

Patient sample and results:
We examined 52 patients with idiopathic osteoporosis detected by a DXA test of LS or the femur in premenopause or within the maximum of 5 years after menopause for the presence of antibodies against gliadins IgA, IgG, endomyzium IgA and transglutaminase IgG. In the case of positive results for any of the antibodies, we also performed gastrofibroscopy and duodenal biopsy. The positivity of antibodies was detected in 21 patients (40.8 %). In 15 (28.8 %) patients, i.e. after the exclusion of Marsh I in 10 patients (19.8 %), histopathology was positive for CD. Significantly higher levels of iPTH (p < 0.001) were detected in patients with CD. We did not find any statistically significant differences in other monitored parameters, i.e. in BMI, S-Ca, S-P, proteins, albumins, immunoglobins IgG, IgA, IgM, dUCa. The differences in the occurrence of prevalent fracture (33.4 or 19.8 %), autoimmune thyreoiditis (20 % or 5.4 %), anemia (33 % or 16.2 %) and dyspepsia (40 % or 24.3 %) were not significant.

Conclusion:
The above results confirm the need for serological screening for CD in premenopausal and early postmenopausal patients with „idiopathic osteoporosis“.

Key words:
celiac disease – idiopathic osteoporosis – serological screening


Sources

1. Pekárková B. Celiakia. In: Jurgoš L, Kužela L, Hrušovský Š et al. Gastroenterologia. Bratislava: VEDA 2006: 335-343.

2. Lukáš M. Celiakie - glutenová enteropatie. Vnitř Lék 2003; 49: 449-451.

3. Frič P. Celiakální sprue (aktuální přehled). Vnitř Lék 2003; 49: 465-473.

4. Prokopová L. Celiakie - závažné onemocnění. Vnitř Lék 2003; 49: 474-481.

5. Frič P. Komplikace celiakální sprue. Čes Slov Gastroent Hepatol 2001; 55: 26-30.

6. Marsh MN, Crowe PT Morphology of the mucosal lesion in gluten sensitivity. Baillerie’s Clin Gastroenterol 1995; 9: 273-293.

7. Oberhuber G, Grandtisch G, Vogelsang H. The histopathology of coeliac disease. Eur J Gastroenterol Hepatol 1999; 11: 1185-1194.

8. Ciferská H, Horák P, Tichý M. Kostní choroba u glutenové enteropatie manifestované v pozdním věku - 2 kazuistiky. Osteologický bulletin 2006; 11: 91-94.

9. Killinger Z, Payer J jr, Huorka M et al. Kostné zmeny u pacientky s asymptomatickou coeliakiou. Osteologický bulletin 1997; 2: 55-57.

10. Lukáš Z. Histopatologie a diferenciální diagnostika celiakální sprue. Čes Slov Patol 2004; 40: 3-6.

11. Fasano A, Catassi C. Curent approaches to diagnosis and therapy of celiac disease: an avolving spectrum. Gastroenterology 2001; 120: 636-651.

12. Plotkin GR, Isselbacher KJ. Secondary dissaccharidase deficiency in adult coeliac disease (nontropical sprue) and other malabsorption states. N Engl J Med 1964; 271: 1033-1037.

13. Di Stefano M, Veneto TG, Malservisi S et al. Lactose malabsorption and intolerance and peak bone mass. Gastroenterology 2002; 122: 1793-1799.

14. Corazza GR, Di Stefano M, Maurino E et al. Bones in coeliac disease: diagnosis and treatment. Best Pract Res Clin Gastroenterol 2005; 19: 453-465.

15. Frič P. Celiakie. In: Bureš J et al. Gastroenterologie. Praha: Triton 2006: 219-238.

16. Goldring SR. Mechanisms of pathologic bone loss. Calcif Tissue Int 2003; 73: 97-100.

17. Sugai E, Chernavsky A, Pedreira S et al. Bone-specific antiobodies in sera from patients with coeliac disease: characterization and implications in osteoporosis. J Clin Immunol 2002; 22: 353-362.

18. Maki M, Colin P. Coeliac disease. Lancet 1997; 349: 1755-1759.

19. Lewis NR, Scott BB. Should patients with coeliac disease ave their bone mineral density measured? Eur J Gastroenterol Hepatol 2005; 17: 1065-1070.

20. Thomason K, West J, Logan RFA et al. Fracture exprience of patients with celiac disease: a population based survey. Gut 2003; 52: 518-522.

21. McFarlane XA, Bhalla AK, Reeves DE et al. Osteoporosis in treated adult coeliac disease. Gut 1995; 36: 710-714.

22. Vančíková Z, Chlumecký V, Sokol D et al. The serologic screening for celiac disease in general population (Blood donors) and in some high-risk groups of adults (patients with autoimmune diseases, osteoporosis and infertility) in Czech Republic. Preliminary Report. Folia Microbiol 2004; 47: 753-758.

23. Sanders DS, Patel D, Khan FB et al. Case finding for Adult Celiac Disease in Patients with Reduced Bone Density. Dig Dis Sci 2005; 50: 587-592.

24. Lindh E, Ljunghall K, Larsson K et al. Screening antibodies against gliadin in patients with osteoporosis. J Intern Med 1992; 231: 403-406.

25. Nuti R, Martini G, Valenti R et al. Prevalence of undiagnosed coeliac syndrome in osteoporotic women. J Intern Med 2001; 250: 361-366.

26. Gokhale YA, Sawant PD, Chodankar CM et al. Celiac Disease in Osteoporotic Indians. JAPI 2003; 51: 579-583.

Labels
Diabetology Endocrinology Internal medicine

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2007 Issue 12

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