BoneKEy-Osteovision | Perspective

Celiac disease: Its effects on bone

Maria L Bianchi
Maria T Bardella

DOI:10.1138/20060212

Abstract

Celiac disease (celiac sprue) is a relatively common intestinal disorder, associated with the ingestion of gluten, a protein found in some cereals. In genetically susceptible subjects, gluten ingestion leads to a chronic alteration of the intestinal mucosa, with loss of villi and proliferation of crypt cells. The overt forms of the disease are characterized by steatorrhea, malabsorption and nutritional deficiencies. Atypical or asymptomatic forms of the disease are more common today. The only effective treatment of celiac disease is a strict, lifelong gluten-free diet, as any ingestion of gluten sets off an inflammatory reaction in the small bowel.

Osteoporosis is a frequent long-term complication of untreated celiac disease, and is now also frequently encountered as the presenting manifestation of asymptomatic forms. Bone remodeling seems to be affected by at least two mechanisms, the first related to malabsorption, the second to the release of inflammatory cytokines. A strict gluten-free diet can bring complete bone recovery in young patients, and is a fundamental therapeutic measure in adults. BMD evaluation is still a matter of discussion, and there is no agreement on the advisability of DXA scans at diagnosis or during follow-up, except in high-risk patients.

The aim of this article is to present state-of-the-art knowledge on the bone complications of celiac disease. The need for further, more focused research on specific aspects of bone metabolism in celiac disease (the role of diet, cytokine studies, BMD evaluation, and specific drug therapy) is emphasized, and the specific requirements of young and adult patients are discussed.

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.