Celiac disease and bone

Area of Science:

• Gastroenterology and Hepatology
• Endocrinology
• Rheumatology

Background:

• Celiac disease (CD) is an autoimmune disorder triggered by gluten, often presenting with extra-intestinal manifestations like metabolic bone disease.
• Metabolic bone disease in CD is associated with an increased risk of fractures, though underlying mechanisms require further elucidation.
• Proposed mechanisms include nutrient malabsorption, inflammatory cytokine effects, hypogonadism, and malnutrition, all contributing to bone loss.

Purpose of the Study:

• To review the current understanding of metabolic bone disease in celiac disease.
• To discuss the impact of CD on bone mineral density and fracture risk.
• To highlight the need for standardized screening and treatment guidelines for bone disease in CD patients.

Main Methods:

• Literature review of studies investigating bone health in celiac disease patients.
• Analysis of proposed mechanisms contributing to bone disease in CD.
• Evaluation of the efficacy of gluten-free diet and potential osteoporosis therapies.

Main Results:

• Most studies report reduced bone mineral density and deteriorated bone microarchitecture in CD patients.
• An increased fracture risk is frequently observed in individuals with CD.
• A gluten-free diet can improve bone mineral density, but levels may remain lower than in controls, and fracture risk can persist.

Conclusions:

• Metabolic bone disease is a significant concern in celiac disease, contributing to fractures.
• Current management with a gluten-free diet shows benefits but may not fully resolve bone density deficits or fracture risk.
• Further research is essential to establish standardized guidelines for screening and treating metabolic bone disease in CD, identifying patients needing early intervention with osteoporosis therapies.