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[Celiac disease and its relation to bone metabolism]
1Endokrinologický ustav, Praha. izofkova@endo.cz
Casopis Lekaru Ceskych
|August 1, 2009
Summary
Celiac disease, an autoimmune disorder triggered by gluten, can lead to bone loss through increased resorption and malabsorption. Early diagnosis and treatment, including a gluten-free diet, are crucial for managing this condition and preventing fractures.
Area of Science:
- Gastroenterology
- Immunology
- Endocrinology
Context:
- Celiac disease (nontropical sprue) is an autoimmune intestinal disorder affecting individuals with gluten hypersensitivity.
- It presents with gastrointestinal symptoms and significant extra-intestinal complications, notably bone metabolism disorders like osteopenia, osteoporosis, and osteomalacia.
- These bone complications arise from cytokine overproduction (IL-1α, IL-1β, TNF-α) promoting bone resorption and hyperparathyroidism due to calcium and vitamin D malabsorption.
Purpose:
- To review the pathogenesis of bone loss in celiac disease.
- To discuss diagnostic criteria and screening recommendations for celiac disease in patients with bone metabolism disturbances.
- To evaluate current and emerging therapeutic strategies for celiac disease and its skeletal manifestations.
Summary:
- Celiac disease is linked to bone loss via increased bone resorption and impaired calcium/vitamin D absorption.
- Diagnosis involves antibody testing and duodenal biopsy; screening in osteoporotic patients is debated, but recommended for specific high-risk groups.
- Management includes a gluten-free diet, calcium/vitamin D supplementation, bisphosphonates, and novel therapies like AT-1001 targeting intestinal repair.
Impact:
- Highlights the critical link between celiac disease and skeletal health, emphasizing the need for integrated patient management.
- Provides guidance on appropriate diagnostic workups and targeted screening for celiac disease in at-risk populations.
- Discusses the efficacy of various treatments, underscoring the potential of new therapeutic agents for improving intestinal healing and bone health.
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