Longitudinal evaluation of bone mineral density and body composition in patients with positive celiac serology

Untreated celiac disease is associated with lower bone mineral density (BMD), body weight and fat mass compared with controls. There are few longitudinal studies examining changes in body composition after celiac disease diagnosis. The aim of this study was to compare changes in BMD and body composition in celiac seropositive cases who had undergone baseline and follow-up dual energy x-ray absorptiometry (DXA) with seronegative controls. Celiac serologic and BMD databases for the Province of Manitoba, Canada, were linked. Endomysial antibody (EMA) seropositive cases and EMA seronegative controls over age 40 who had serologic testing within 6 months of DXA testing and a follow-up DXA were extracted from the databases. Changes in BMD, BMI and body composition were compared in the 2 groups. The 43 EMA seropositive cases had lower baseline spine and hip BMD, BMI and fat measurements compared with 233 EMA seronegative controls. For seropositive versus seronegative individuals there were greater increases in mean spine BMD (4.6%/year vs 0.7% spine, p < 0.0001), hip BMD (3.0 %/year vs 0.2%/year hip, p < 0.0001), and body weight (2.8%/year vs 0.3%/year, p < 0.0001). Increases in mean abdominal fat (2.4%/year vs 0.4%/year, p < 0.0001) were also greater in seropositive versus seronegative individuals, while increases in hip fat were less marked (0.9%/year vs 0.3%/year, p = 0.0071). This longitudinal database study documents significant improvements in BMD in seropositive cases. BMI and fat measures also increased, with the abdominal fat compartment demonstrating the greatest increase. Further studies are needed to determine the clinical significance of this regional increase in abdominal fat.