title: Abnormal Skeletal Strength and Microarchitecture in Women With Celiac Disease.
abstract: BACKGROUND
  Osteoporosis is often a presenting sign of celiac disease (CD). Whether skeletal fragility in CD is associated with microarchitectural abnormalities is not known.
  
  
  OBJECTIVE
  The objective of the study was to evaluate microarchitecture and biomechanical properties of bone in CD.
  
  
  METHODS
  This was a case-control study.
  
  
  METHODS
  The study was conducted at a university hospital outpatient facility.
  
  
  METHODS
  Patients included premenopausal women with newly diagnosed CD (n = 33) and healthy controls (n = 33).
  
  
  METHODS
  Areal bone mineral density by dual-energy x-ray absorptiometry was measured as was trabecular and cortical volumetric bone mineral density (vBMD) and microarchitecture by high-resolution peripheral computed tomography of the distal radius and tibia. Whole-bone stiffness estimated by finite element analysis. PTH, 25-hydroxyvitamin D, and bone turnover markers were also measured.
  
  
  RESULTS
  Groups had similar age, race, and body mass index. Both groups had sufficient 25-hydroxyvitamin D and normal calcium and PTH. Areal bone mineral density was lower in CD. By high-resolution peripheral computed tomography, CD had lower trabecular vBMD, fewer, more widely, and irregularly spaced trabeculae at both the radius and tibia (8%-33%). At the tibia, they also had lower total density (8%) and thinner cortices (10%). Whole-bone stiffness and failure load were lower (11%-21%) in CD at both sites. Biomechanical deficits were associated with trabecular abnormalities.
  
  
  CONCLUSIONS
  Women with CD had abnormal vBMD and microarchitecture at both the radius and tibia. Trabecular bone was preferentially affected. These deficits were associated with lower estimates of skeletal strength. These findings suggest a potential structural mechanism for skeletal fragility in CD and support further research into the pathogenesis of fracture in this population.
authors: Divisions of Endocrinology and Gastroenterology (E.M.S., H.R., A.L., D.J.M., P.Y., K.N.,S.L., P.H.G., E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027.
authors: Emily M
authors: EM
authors: Stein
authors: Divisions of Endocrinology and Gastroenterology (E.M.S., H.R., A.L., D.J.M., P.Y., K.N.,S.L., P.H.G., E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027.
authors: Halley
authors: H
authors: Rogers
authors: Divisions of Endocrinology and Gastroenterology (E.M.S., H.R., A.L., D.J.M., P.Y., K.N.,S.L., P.H.G., E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027.
authors: Alexa
authors: A
authors: Leib
authors: Divisions of Endocrinology and Gastroenterology (E.M.S., H.R., A.L., D.J.M., P.Y., K.N.,S.L., P.H.G., E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027.
authors: Donald J
authors: DJ
authors: McMahon
authors: Divisions of Endocrinology and Gastroenterology (E.M.S., H.R., A.L., D.J.M., P.Y., K.N.,S.L., P.H.G., E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027.
authors: Polly
authors: P
authors: Young
authors: Divisions of Endocrinology and Gastroenterology (E.M.S., H.R., A.L., D.J.M., P.Y., K.N.,S.L., P.H.G., E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027.
authors: Kyle
authors: K
authors: Nishiyama
authors: Divisions of Endocrinology and Gastroenterology (E.M.S., H.R., A.L., D.J.M., P.Y., K.N.,S.L., P.H.G., E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027.
authors: X Edward
authors: XE
authors: Guo
authors: Divisions of Endocrinology and Gastroenterology (E.M.S., H.R., A.L., D.J.M., P.Y., K.N.,S.L., P.H.G., E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027.
authors: Suzanne
authors: S
authors: Lewis
authors: Divisions of Endocrinology and Gastroenterology (E.M.S., H.R., A.L., D.J.M., P.Y., K.N.,S.L., P.H.G., E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027.
authors: Peter H
authors: PH
authors: Green
authors: Divisions of Endocrinology and Gastroenterology (E.M.S., H.R., A.L., D.J.M., P.Y., K.N.,S.L., P.H.G., E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027.
authors: Elizabeth
authors: E
authors: Shane
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000502:physiology*; D002118:Calcium / Q000097:blood; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism; D019245:Compressive Strength; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D055815:Young Adult
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium