People with celiac disease more likely to fracture bones

By Katryn Doyle

(Reuters Health) - People diagnosed with celiac disease are almost twice as likely as those without it to break a bone, according to a new review of the evidence.

More studies are needed, though, to see if people whose celiac disease hasn't been diagnosed yet are at similar risk, researchers say.

For the new review, researchers from the University of Tampere and Seinäjoki Central Hospital in Finland, and the University of Nottingham in the UK analyzed 16 studies that compared the incidence of bone fractures among people with and without a celiac disease diagnosis.

In studies that looked at one point in time, people with celiac disease were almost twice as likely to have had a bone fracture in the past.

In studies that followed people over time, those who had a diagnosis of celiac disease at the start were about 30% more likely to suffer a bone fracture and 69% more likely to have a hip fracture than others, according to the analysis published October 3rd online in the Journal of Clinical Endocrinology and Metabolism.

There were only two studies of bone fractures among people with undiagnosed celiac disease - but whose blood tests showed celiac-specific antibodies - and it was not clear if there was a link to broken bones, the authors write.

Since the disease affects nutrient absorption in the small intestine, it could lead to poor absorption of vitamin D and calcium, or chronic intestinal inflammation could interfere with bone formation, they write.

Other possibilities to explain the connection to fractures include hormonal changes or a gluten-free diet, which is often low in minerals, they write.

Other studies have found that bone density tends to go down as symptoms become worse for people with celiac disease, according to Professor Julio C. Bai at the Hospital de Gastroenterologia Dr. Carlos Bonorio Udaondo in Buenos Aires, Argentina.

"Therefore and based on our findings, it seems reasonable to consider to evaluate bone density in those patients with symptomatic celiac disease," said Bai, who was not involved in the new study.

"Some areas of bone are more vulnerable to the damage induced by celiac disease," said Dr. Peter H.R. Green, an expert on celiac disease at Columbia University in New York who wasn't involved in the new review. "This relates to the type of bone and its rate of turnover."

Everyone newly diagnosed with celiac disease should routinely undergo a bone density scan, he told Reuters Health by email.

"We have shown that a gluten free diet together with replacement of calcium and vitamin D, when necessary, results in improvement in bone density," he said.

SOURCE: http://bit.ly/1yrO6yQ

J Clin Endocrinol Metab 2014.

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