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This article is featured in a Reuter's Health story, "Early Onset
Osteoporosis Could Be Due to Occult Celiac Disease" at Medscape.com (you
need to be registered with Medscape (free) to read it):

http://www.medscape.com/viewarticle/456922

The full text of the article is available free in PDF format at:

http://www.japi.org/June2003/O-579.pdf

J Assoc Physicians India June 2003;51:579-584

Celiac Disease in Osteoporotic Indians

YA Gokhale, PD Sawant, CM Chodankar, ND Desai, MV Patil, S Maroli, MN
Patil, NK Hase

Abstract

Objective:
1) The aim of the study was to identify the atypical celiac disease (CD) in
a cohort of symptomatic osteoporotic patients,younger than 55 years of age
and 2) To study associated clinical and laboratory features and outcome
with gluten-free diet.

Material and Methods:
We studied 33 patients (F:M =28:5),mean age 29 years (range 15-52 years)
with osteoporosis (WHO diagnostic criteria,T-score less than -2.5 on DEXA
scan) from January 2000-June 2002.  Serological screening for CD was done
by detecting circulating IgA antibodies to tissue
transglutaminase by ELISA.  Patients with presence of antibodies to
transglutaminase were subjected to biopsy from the 2nd part of the duodenum
by upper GI endoscopy.  The biopsies were reported independently by two
pathologists who were blinded for the serology report.  Measurement of
mucosal thickness,crypts and villi were done with an ocular micrometer.
Other parameters like complete hemogram, serum iron,total iron binding
capacity (TIBC),calcium profile,25-OH-D, parathyroid hormone (PTH) were
evaluated.  Assessment of clinical and laboratory parameters was performed
within 4-12 weeks of starting gluten-free diet (GFD).

Results:
Thirteen patients had circulating IgA antibodies to
transglutaminase.Intestinal biopsies were performed on 11 patients and were
consistent with the diagnosis of CD (total villous atrophy -two, subtotal
villous atrophy with crypt hyperplasia -nine). Patients with CD had
significant anaemia when compared with non-CD osteoporotic patients.  Other
important observations in these 11 patients were low serum calcium and
phosphorus, low 25-OH-D, high PTH.  Significant improvement in clinical and
laboratory parameters was noted in all patients within 6-12 weeks of
starting GFD.

Conclusion:
Symptomatic osteoporotic patients (younger than 55 years of age) especially
with associated anaemia should be investigated for CD.  Simple measures
like omission of wheat from diet (GFD) lead to significant improvement in
symptoms within weeks.

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