The effects of 1-year gluten withdrawal on bone mass, bone metabolism and nutritional status in newly-diagnosed adult coeliac disease patients.
OBJECTIVE
To evaluate the impact of a 1-year gluten-free diet on bone metabolism and nutritional status in coeliac disease.


METHODS
Bone mineral density, serum indices of bone remodelling, clinical and biochemical nutritional assessment were evaluated in 86 consecutive newly-diagnosed, biopsy proven, coeliac disease patients (untreated). A complete reevaluation, including intestinal biopsy, was repeated within 1 year of dietary treatment (treated).


RESULTS
Untreated: according to WHO criteria, 34% of patients had a normal bone mineral density, 40% had osteopenia and 26% osteoporosis. Between males and females there were no statistical differences in bone metabolism or in most of the nutritional indices, while, between fertile and postmenopausal women, bone mineral density and several bone metabolism markers were significantly different. Compared to subjects with a normal bone mineral density, osteopenics had higher bone specific alkaline phosphatase (BAP) and Bone-Gla-protein (BGP) values. In patients with a concomitant BAP increase and 25OH vitamin D serum level reduction, bone mineral density and several bone turnover markers were statistically different compared to patients without such a serological pattern. Treated: notwithstanding intestinal biopsy which showed a mucosal recovery in only 57%, gluten-free diet led, even in postmenopausal women, to a significant improvement in bone mineral density, bone metabolism and nutrition, except for folic acid, albumin and pre-albumin serum levels which persisted as abnormal in patients with obdurate mucosal impairment.


CONCLUSIONS
Coeliac disease patients are at high risk for developing a low bone mineral density and bone turnover impairment. A gluten-free diet can improve this situation even in postmenopausal women and in patients with incomplete mucosal recovery.
Sategna-Guidetti
C
C
Dipartimento di Medicina Interna, Universitá di Torino, Italy. carla.sategna@unito.it
Grosso
S B
SB
Grosso
S
S
Mengozzi
G
G
Aimo
G
G
Zaccaria
T
T
Di Stefano
M
M
Isaia
G C
GC
D000328:Adult; D000368:Aged; D015415:Biomarkers; D015519:Bone Density / Q000502:physiology*; D001846:Bone Development / Q000502:physiology; D016723:Bone Remodeling / Q000187:drug effects; D001862:Bone Resorption / Q000378:metabolism; D001842:Bone and Bones / Q000378:metabolism*; D002118:Calcium / Q000097:blood / Q000378:metabolism; D002446:Celiac Disease / Q000178:diet therapy* / Q000473:pathology; D004035:Diet Therapy / Q000009:adverse effects*; D004573:Electrolytes / Q000097:blood; D005260:Female; D005983:Glutens; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010349:Patient Compliance; D011446:Prospective Studies
D015415:Biomarkers; D004573:Electrolytes; D005983:Glutens; D002118:Calcium