A DXA-based profile of body composition in celiac patients: a cross-sectional retrospective study

Celiac disease (CD) is frequently associated with bone and mineral metabolism alterations. As the clinical phenotype shifts from malabsorptive to normal-weight or obese, precise evaluation of body composition is essential to assess metabolic and sarcopenia risks. This study utilized Dual-Energy X-ray Absorptiometry (DXA) to characterize body composition and Bone Mineral Density (BMD) in a contemporary adult CD cohort.

We conducted a single-center, retrospective observational study of 77 CD patients (73% female) under 52 years of age; menopausal women were excluded. DXA was used to measure Appendicular Lean Mass Index (ALMI) Z-score, Bone Mineral Content (BMC) Z-score, and Total BMD Z-score.

Soft tissue parameters, including ALMI and fat mass Z-scores, clustered around zero for both sexes, indicating a composition profile comparable to the NHANES reference population. Conversely, bone health was consistently compromised, especially in women. Female patients exhibited negative Total BMD Z-scores across all age groups, with the lowest mean in the 40-44 age cohort (- 1.0 ± 1.0). BMC Z-scores were also predominantly negative (e.g., - 1.1 ± 1.5 in the 40-44 group). Male patients showed heterogeneous BMD Z-scores, ranging from - 1.04 ± 1.0 (25-29 years) to positive values in older subgroups.

In this cohort, the modern CD phenotype presents a preserved soft tissue composition. However, low BMD remains a persistent finding, particularly in premenopausal women. These results underscore the necessity of systematic DXA screening in adult CD patients, regardless of their body mass index or clinical presentation.