 |
|
Increased Prevalence of Celiac Disease and Need for Routine Screening Among Patients With Osteoporosis
William F. Stenson, MD;
Rodney Newberry, MD;
Robin Lorenz, MD, PhD;
Christine Baldus, RN, BSN;
Roberto Civitelli, MD
Arch Intern Med. 2005;165:393-399.
Background There is an increased prevalence of osteoporosis among patients with celiac disease. However, the relative prevalence of celiac disease among osteoporotic and nonosteoporotic populations is not known, and the benefit of screening the osteoporotic population for celiac disease remains controversial.
Methods We evaluated 840 individuals, 266 with and 574 without osteoporosis, from the Washington University Bone Clinic by serologic screening for celiac disease. Individuals with positive serologic test results for antitissue transglutaminase or antiendomysial antibody were offered endoscopic intestinal biopsy to confirm the diagnosis of celiac disease. Individuals with biopsy-proven celiac disease were treated with a gluten-free diet and followed up for improvement in bone mineral density.
Results Twelve (4.5%) of 266 patients with osteoporosis and 6 (1.0%) of 574 patients without osteoporosis tested positive by serologic screening for celiac disease. All but 2 serologically positive individuals underwent in-testinalbiopsy. Nine osteoporotic patients and 1 nonosteoporotic patient had positive biopsy results. The prevalence of biopsy-proven celiac disease was 3.4% among the osteoporotic population and 0.2% among the nonosteoporotic population. All biopsy-positive individuals tested positive by antitissue transglutaminase and antiendomysial antibody. The antitissue transglutaminase levels correlated with the severity of osteoporosis as measured by T score, demonstrating that the more severe the celiac disease the more severe the resulting osteoporosis. Treatment of the patients with celiac disease with a gluten-free diet resulted in marked improvement in T scores.
Conclusions The prevalence of celiac disease among osteoporotic individuals (3.4%) is much higher than that among nonosteoporotic individuals (0.2%). The prevalence of celiac disease in osteoporosis is high enough to justify a recommendation for serologic screening of all patients with osteoporosis for celiac disease.
Author Affiliations: Divisions of Gastroenterology (Drs Stenson and Newberry) and Bone and Mineral Metabolism (Ms Baldus and Dr Civitelli), Washington University School of Medicine, St Louis, Mo; and Department of Pathology, University of Alabama School of Medicine, Birmingham (Dr Lorenz).
RELATED LETTERS
Celiac Disease and Osteoporosis
Robert Hoyt
Arch Intern Med. 2005;165(16):1922.
EXTRACT
| FULL TEXT
Celiac Disease and Osteoporosis—Reply
William F. Stenson
Arch Intern Med. 2005;165(16):1922-1923.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Population-Based Screening for Celiac Disease: Improvement in Morbidity and Mortality From Osteoporosis?
Alan L. Buchman
Arch Intern Med. 2005;165(4):370-372.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Patient Assessment in the Diagnosis, Prevention, and Treatment of Osteoporosis
Lata and Elliott
Nutr Clin Pract 2007;22:261-275.
ABSTRACT
| FULL TEXT
Celiac Disease: Its Effects on Bone
Bianchi and Bardella
IBMS BoneKEy 2006;3:30-38.
ABSTRACT
| FULL TEXT
Celiac Disease and Osteoporosis
Hoyt
Arch Intern Med 2005;165:1922-1922.
FULL TEXT
Celiac Disease and Osteoporosis--Reply
Stenson
Arch Intern Med 2005;165:1922-1923.
FULL TEXT
Screening for Osteoporosis
Raisz
NEJM 2005;353:164-171.
FULL TEXT
Population-Based Screening for Celiac Disease: Improvement in Morbidity and Mortality From Osteoporosis?
Buchman
Arch Intern Med 2005;165:370-372.
FULL TEXT
|
