OSTEOPOROSIS IN TREATED ADULT CELIAC-DISEASE

Forty five women and 10 men with coeliac disease diagnosed in adult li fe, who were already on a gluten free diet, had serial bone mineral de nsity measurements at the lumbar spine and femoral neck over 12 months . Osteoporosis, defined as a bone mineral density (BMD) less than or e qual to 2 SD below the normal peak bone mass was found in 50% of male and 47% of female coeliac patients. Patients with a BMD less than or e qual to 2 SD below age and sex matched normal subjects, had a signific antly lower body mass index (21.3 kg . m(-2) compared with 25.2 kg . m (-2), p<0.02 Wilcoxon rank sum test) and lower average daily calcium i ntake (860 mg/day compared with 1054 mg/day, p<0.05 Wilcoxon rank sum test) than patients with normal bone mineral density. In postmenopausa l women with coeliac disease there was a strong correlation between th e age at menopause and BMD at both the lumbar spine (r=0.681, p<0.01, Spearman's rank correlation) and femoral neck (r=0.632, p<0.01). No ov erall loss of bone was shown over the 12 months of follow up, and rela tive to the reference population there was a significant improvement i n BMD at the lumbar spine in women (p<0.025, paired t test) and at the femoral neck in men (p<0.05, paired t test). There was a significant negative correlation between the annual percentage change in BMD at th e lumbar spine and the duration of gluten free diet (r=-0.429, p<0.01, Spearman's rank correlation), with the largest gain in BMD in patient s with most recently diagnosed coeliac disease. Osteoporosis was shown in 47% of patients with treated adult coeliac disease. Recognised ris k factors for osteoporosis in the general population including low bod y mass index, dietary calcium intake, and early menopause are particul arly important in coeliac disease. Treatment of coeliac disease with a gluten free diet probably protects against further bone loss, and in the early stages is associated with a gain in bone mineral density.