EFFECT OF TREATMENT ON BONE MASS, MINERAL METABOLISM, AND BODY-COMPOSITION IN UNTREATED CELIAC-DISEASE PATIENTS

Background/Aims: Osteopenia is a common complication of celiac disease . The aims of this study were to evaluate whether treatment produces b one remineralization and whether calcium and vitamin D supplementation are necessary to reduce osteopenia. Methods: Bone mineral density and biochemical parameters of bone and mineral metabolism were measured i n 14 newly diagnosed adult celiac disease patients. All patients were treated with a gluten-free diet and were randomized to receive diet on ly (n = 7) or diet plus calcium (1.0 g/day) and vitamin D (32,000 IU/w k) supplementation (n = 7). Bone density was measured at baseline and at 6 and 12 months of follow-up. Tests for biochemical determinations were repeated every 3 months. Results: At diagnosis, 11 patients had e vidence of osteopenia (>1 SD below normality) in the spine and total s keleton. After 12 months of gluten restriction, overall bone mass had increased 5.0% (p < 0.01) in the lumbar spine and 5.0% (p < 0.002) in the total skeleton. When one only considers those 11 patients who stri ctly followed gluten restriction, bone density increased 8.4% in the l umbar spine and 7.7% in the total skeleton. Remineralization occurred throughout the skeleton but was more pronounced in the axial than in t he peripheral skeleton. The increase in bone mass was independent of a ge or menopause. Remineralization in patients treated with diet only w as similar to that of patients treated with diet and supplements. Basa l biochemical parameters showed a high bone turnover with secondary hy perparathyroidism. Treatment induced a decrease in bone turnover activ ity. However, a complete restoration of biochemical parameters was not achieved. Conclusions: Strict gluten avoidance promoted a significant increase in bone mineral density. However, values still remain marked ly low after 1 yr in several patients. Although calcium and vitamin D supplementation did not provide additional benefit to that obtained by diet alone in the doses administered, our results do not preclude a p ossible effect of vitamin D at higher dose.