BONE MASS AND METABOLISM IN PATIENTS WITH CELIAC-DISEASE

Background & Aims: Several aspects of the pathogenesis of osteopenia i n celiac disease are still unclear. Therefore, bone mass and metabolis m were evaluated in adults with celiac disease in a cross-sectional st udy. Methods: Bone mineral density (BMD), assessed by total body dual- photon absorptiometry, and serum indices of bone metabolism and remode ling were evaluated in 17 patients with untreated celiac disease, 14 w ith celiac disease on a gluten-free diet, and 24 healthy volunteers. R esults: BMD, expressed as a z score, was significantly lower in patien ts with untreated celiac disease than in patients with treated celiac disease and volunteers and lower in patients with treated celiac disea se than in volunteers. Similar changes were observed in serum calcium level, whereas intact parathyroid hormone level was significantly high er in untreated than in treated patients with celiac disease and volun teers, and no difference was found between the latter two groups. 25-V itamin D level was significantly lower and 1,25-vitamin D level signif icantly higher in untreated celiac disease than in treated celiac dise ase and volunteers. Indices of bone remodeling were significantly high er in untreated than in treated patients and volunteers and significan tly and positively correlated with iPTH in untreated patients with cel iac disease. Conclusions: BMD is almost invariably low in patients wit h untreated celiac disease. Results in treated patients suggest that g luten-free diet improves but does not normalize BMD. Untreated celiac disease is characterized by high levels of 1,25-vitamin D and by incre ased bone turnover, caused by the increase in intact parathyroid hormo ne level.