Prevalence of Osteopenia and Osteoporosis in Patients with Celiac Disease in Northeastern Iran

Abstract

Background

Celiac disease is an autoimmune disorder which causes malabsorption in genetically susceptible patients who consume gluten. Celiac disease is not limited to the gastrointestinal system, and exhibits different signs and symptoms in other organs. Malabsorption of calcium and vitamin D can cause osteomalacia and secondary hyperparathyroidism. Celiac disease is no longer a rare disease and is more frequent in the Middle East. It is expected that 1% of the in general population has celiac disease. This study aims to determine the prevalence of osteopenia and osteoporosis in Iranian patients with celiac disease.

Materials and Methods

Individuals with intestinal and extra-intestinal problems who had positive serologic tests for anti-tissue transglutaminase or antiendomysial antibody were offered endoscopic duodenal biopsy to confirm their diagnoses of celiac disease. Biopsy-proven celiac disease patients between the ages of 20 to 60 years were enrolled. Exclusion criteria were as follows: 1) the use of drugs such as corticosteroids, anticonvulsants, heparin, cyclosporine, statins, and β-blockers, 2) the presence of any neoplasm, and 3) any metabolic disorder such as diabetes, hyperthyroidism, Cushing's, and immobility. After obtaining informed consents, we evaluated 76 patients diagnosed with celiac disease. All enrolled patients underwent BMD measurement of the hip, femoral neck, and spine using dual-energy X-ray absorptiometry (bone densitometry with DEXA scan).

Results

A total of 76 patients with celiac disease of ages 20 to 60 years old (mean: 33 years old) underwent bone densitometry. Of these, 66% were female and 33% were male. There were 44 patients (57%) who had normal bone density in the spine, 17 (22.4%) who had osteopenia, and 15 patients (20%) had osteoporosis. In the femoral neck, 38 patients (50%) had normal bone densitometry, 25 (32.9%) had osteopenia, and 12 (15.8%) had osteoporosis. Low bone mineral density (osteoporosis or osteopenia) was seen in 48% of our patients in the femoral neck and 43% in the spine.

Conclusion

The prevalence of osteoporosis among celiac disease is much higher than the general population. Of the study patients, 55% had osteopenia in the femoral neck or spine and 36% had osteoporosis in the femoral neck or spine. The prevalence of osteoporosis is elevated enough to justify a recommendation for osteoporosis screening of all patients with celiac disease.