The effects of 1-year gluten withdrawal on bone mass, bone metabolism and nutritional status in newly-diagnosed adult coeliac disease patients

Objectives: To evaluate the impact of a 1-year gluten-free diet on bone met abolism and nutritional status in coeliac disease. Methods: Bone mineral density, serum indices of bone remodelling, clinical and biochemical nutritional assessment were evaluated in 86 consecutive new ly-diagnosed, biopsy proven, coeliac disease patients (untreated). A comple te revaluation, including intestinal biopsy, was repeated within 1 year of dietary treatment (treated). Results: Untreated: according to WHO criteria, 34% of patients had a normal bone mineral density, 40% had osteopenia and 26% osteoporosis. Between mal es and females there were no statistical differences in bone metabolism or in most of the nutritional indices, while, between fertile and postmenopaus al women, bone mineral density and several bone metabolism markers were sig nificantly different. Compared to subjects with a normal bone mineral densi ty, osteopenics had higher bone specific alkaline phosphatase (BAP) and Bon e-Gla-protein (BGP) values. In patients with a concomitant BAP increase and 25OH vitamin D serum level reduction, bone mineral density and several bon e turnover markers were statistically different compared to patients withou t such a serological pattern. Treated: notwithstanding intestinal biopsy wh ich showed a mucosal recovery in only 57%, gluten-free diet led, even in po stmenopausal women, to a significant improvement in bone mineral density, b one metabolism and nutrition, except for folic acid, albumin and pre-albumi n serum levels which persisted as abnormal in patients with obdurate mucosa l impairment. Conclusions: Coeliac disease patients are at high risk for developing a low bone mineral density and bone turnover impairment. A gluten-free diet can improve this situation even in postmenopausal women and in patients with in complete mucosal recovery.