INFLUENCE OF PATTERN OF CLINICAL PRESENTATION AND OF GLUTEN-FREE DIETON BONE MASS AND METABOLISM IN ADULT CELIAC-DISEASE

Since no information is available on bone derangements in subclinical coeliac disease (CD), we evaluated bone mineral density (BMD, expresse d as z score) at lumbar spine, by Xray dual-photon absorptiometry, and serum indices of bone metabolism and remodeling in 14 subclinical or silent patients, 10 classical patients, and 15 healthy volunteers all on a gluten-containing diet, In the subclinical group, BMD at lumbar s pine was significantly higher than in the classical group (-1.3 +/- 0. 8, 73% vs, -2.6 +/- 0.6, 88%, respectively; p < 0.001), but significan tly lower than in volunteers (+0.4 +/- 1.1, 104%; p < 0.001). Similar changes were observed in serum calcium, whereas, as regards parathyroi d hormone, no significant difference was found between subclinical and classical patients, 25-vitamin D was significantly lower, and 1,25-vi tamin D was significantly higher in subclinical and classical patients than in healthy volunteers, Indices of bone remodeling were higher in the subclinical and classical groups than in the volunteers, but lowe r in the subclinical than in classical patients, Eight subclinical and 8 classical patients were reexamined after a period of gluten-free di et (GFD), and in both groups BMD had significantly improved, Our resul ts show that osteopenia is a frequent feature also in subclinical CD, although the extent of bone and mineral metabolism derangements is low er than in classical CD. GFD is able to normalize BMD in subclinical a nd to significantly improve it in classical patients.