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S(Arch Intern Med. 2005; 165:393-399)


Screening patients with osteoporosis for celiac disease appears worthwhile


CHICAGO - 

Results of a new study suggest that the higher prevalence of celiac disease
in individuals with osteoporosis than in the general population may justify
screening of patients with osteoporosis for celiac disease, according to an
article in the February 28 issue of Archives of Internal Medicine, one of
the JAMA/Archives journals. 

Patients with celiac disease have an inappropriate immune response to
gluten, a component of wheat proteins, which makes it difficult to properly
digest many foods, according to background information in the article.
Although adults diagnosed with celiac disease commonly have a low bone
mineral density (BMD) and treatment with a gluten-free diet increases their
BMD, there has not been clear evidence of the benefit of screening everyone
with osteoporosis for celiac disease. 

William F. Stenson, M.D., of Washington University School of Medicine, St.
Louis, and colleagues evaluated 840 individuals, 266 with and 574 without
osteoporosis from the Washington University Bone Clinic by serologic
screening for celiac disease (blood test for antibodies associated with
celiac disease). The diagnosis of celiac disease was then confirmed with an
intestinal biopsy and individuals with a confirmed diagnosis were treated
with a gluten-free diet and followed up for improvement in BMD. 

Twelve of the 266 patients with osteoporosis and six of those without
osteoporosis tested positive by serological screening for celiac disease,
the researchers found. Nine patients with osteoporosis (3.4 percent) and one
of those without osteoporosis (0.2 percent) had biopsy-proven celiac
disease. Further, the authors write, ".the more severe the celiac disease,
the more severe the resulting osteoporosis." 

"Treatment with a gluten-free diet for a year resulted in improved BMD in
individuals with celiac disease and osteoporosis," the authors write. "The
improvement in BMD for celiac disease patients on the gluten-free diet was
greater than that expected for osteoporotic patients receiving standard
therapy." 

"In conclusion, we found that the prevalence of celiac disease among
osteoporotic patients was much higher than among the nonosteoporotic
population and high enough to justify a recommendation that all individuals
with osteoporosis undergo serologic screening for celiac disease," the
researchers state. ".individuals with positive serological screening should
be evaluated with endoscopy and small-intestine mucosal biopsy to establish
the diagnosis of celiac disease. Treatment of these individuals with a
gluten-free diet will improve their BMD."

 Janet Rinehart, Chairman, Houston Celiac Support Group

 

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