title: Bone mineral density directly correlates with duodenal Marsh stage in newly diagnosed adult celiac patients.
abstract: OBJECTIVE
  To estimate the prevalence of low bone mineral density (BMD) in a prospective series of adult celiac patients and to identify nutritional and metabolic factors associated with osteoporosis and osteopenia.
  
  
  METHODS
  Patients over 18 years of age who were consecutively and newly diagnosed with celiac disease (CD) were recruited. A bone density scan with dual-energy X-ray absorptiometry was carried out on the left hip and lumbar spine; nutritional parameters were analyzed and a hormone study conducted in order to exclude secondary low BMD.
  
  
  RESULTS
  40 patients (36 females/4 males) between the ages of 18 and 68 (mean 44.25 years) were recruited. Overall, at the moment of diagnosis 45% of patients exhibited low BMD at both demarcations. Risk of hip fracture was generally low, but ascended to mild in patients with villous atrophy (p = 0.011). Differences in major fracture risk were also observed depending on Marsh stage (p = 0.015). Significant differences were observed in nutritional status between patients with and without duodenal villous atrophy, with body mass index and blood levels of prealbumin, iron, vitamin D and folic acid significantly lower in Marsh III stage patients. No differences were found in blood hormone levels between Marsh stages or BMDs. The degree of bone mass loss in the lumbar spine directly correlated to Marsh stage. In the hip, a parallel association between BMD and Marsh stage was also observed, but did not reach statistical significance.
  
  
  CONCLUSIONS
  Duodenal villous atrophy, through malabsorption, was the main determinant factor for low BMD in adult-onset CD patients.
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Hospitalario Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: García-Manzanares
authors.forename: José M
authors.initials: JM
authors.lastname: Tenias
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Lucendo
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015519:Bone Density; D002446:Celiac Disease / Q000150:complications / Q000378:metabolism* / Q000473:pathology*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005492:Folic Acid / Q000097:blood; D006615:Hip / Q000000981:diagnostic imaging; D006620:Hip Fractures / Q000150:complications; D006801:Humans; D007501:Iron / Q000097:blood; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010024:Osteoporosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000378:metabolism; D011228:Prealbumin; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D055815:Young Adult
chemical_list: D011228:Prealbumin; D014807:Vitamin D; D005492:Folic Acid; C104450:25-hydroxyvitamin D; D007501:Iron