title: Impact of a gluten-free diet on bone mineral density in celiac patients.
abstract: BACKGROUND
  Osteoporosis (OP) is a metabolic bone illness that may complicate celiac disease (CD). It can lead to devastating consequences because of low bone mass and fragility fractures.
  
  
  OBJECTIVE
  To study the OP prevalence in a group of Brazilian patients with CD and the value of a gluten free diet (GFD).
  
  
  METHODS
  Retrospective study of celiac female patients from a single University Center followed with bone densitometries. Results from densitometry made at first visit were compared with a second study after a median time of 5 years. During this period, patients were submitted to a GFD according to orientations from special program training. Calcium and vitamin D were prescribed to those patients who did not reach the minimal daily requirement through diet.
  
  
  RESULTS
  Forty-one celiac female patients, mean age 46.1 ± 14.8 years, were included. The prevalence of osteopenia at first visit was 56.1% and that of osteoporosis 29.2%. Osteoporosis was associated with longer disease duration (p = 0.01). The second densitometry was performed in a median time of 5 years (range 1 to 13 years) and disclosed 58.9% osteopenia and 28.2% osteoporosis. The GFD improved bone mass, mainly at (of) spine (comparison of T score with p = 0.03 and of bone mass in g/cm2 with p = 0.02), but it was not sufficient to reduce the number of osteopenic (p = 0.9) and osteoporotic patients (p = 0.4). During the follow up period 25% of osteoporotic patients developed low impact fractures.
  
  
  CONCLUSIONS
  Bone health is notably impaired at baseline in CD patients, especially in those with a diagnostic delay. A GFD modestly improved bone mass density with low impact fractures occurring in one third of patients during the follow up period.
authors.affiliation: Service of Gastroenterology, Cajuru Hospital, Pontifical Catholic University of Paraná , Brazil.
authors.forename: Lorete M S
authors.initials: LM
authors.lastname: Kotze
authors.affiliation: Rheumatology Unit, Evangelical University, Brasil.
authors.forename: Thelma
authors.initials: T
authors.lastname: Skare
authors.affiliation: Rheumatology Unit, Evangelical University, Brasil.
authors.forename: Antonella
authors.initials: A
authors.lastname: Vinholi
authors.affiliation: Rheumatology Unit, Evangelical University, Brasil.
authors.forename: Leandro
authors.initials: L
authors.lastname: Jurkonis
authors.affiliation: Medicine, Positivo Universtiy, Brasil.
authors.forename: Renato
authors.initials: R
authors.lastname: Nisihara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D001938:Brazil; D002446:Celiac Disease / Q000150:complications / Q000178:diet therapy*; D055050:Diet, Gluten-Free; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult