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Skeletal fragility, lower bone strength evident in women with celiac disease
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Premenopausal women with celiac disease may be more likely to have lower bone strength, even with sufficient levels of calcium, vitamin D and parathyroid hormone, according to research in The Journal of Clinical Endocrinology & Metabolism.
In a case-control study, researchers linked biomechanical deficits to abnormalities in trabecular volumetric bone mineral density and microarchitecture, despite sufficient calcium, 25-hydroxyvitamin D and normal parathyroid hormone levels at the time of evaluation.
“This study demonstrated for the first time that premenopausal women with celiac disease have lower volumetric BMD, abnormal microarchitecture and lower strength, measured as stiffness and failure load compared to normal premenopausal women of similar age, BMI, gender and race/ethnicity,” the researchers wrote. “In contrast to our hypothesis that cortical abnormalities would predominate, we found pronounced deficits in trabecular bone, which were associated with impaired biomechanical properties.”
Emily M. Stein, MD, of the department of medicine at Columbia University College of Physicians and Surgeons in New York, and colleagues compared data from 33 premenopausal women with newly diagnosed celiac disease with 33 healthy controls, using DXA to measure areal BMD at the lumbar spine, total hip, femoral neck, ultradistal radius and the 1/3 radius and high-resolution peripheral quantitative CT to measure volumetric BMD, bone size and cortical and trabecular microarchitecture.
Areal BMD measurements for participants with celiac disease were significantly lower compared with healthy controls. At the radius, the total cross-sectional area was smaller in patients with celiac disease (–8.4%; P < .02), as were cortical (–8.9%; P = .07) and trabecular compartments (–8.3%; P = .07), according to researchers.
Patients with celiac disease also had lower trabecular density (–16.9%; P < .009) and number (–10.9%; P < .02) and greater trabecular separation (18.4%; P < .007) and network heterogeneity (32.6%; P < .02). Trabecular thickness also was lower for participants with celiac disease, although total and cortical density and cortical thickness did not differ between the two groups.
Patients with celiac disease also had lower whole-bone stiffness at both the radius and tibia, with failure load lower at the radius and tibia for the same group — both associated with worse microarchitectural parameters, according to researchers.
There was no difference in volumetric BMD or any microarchitecture variables between patients who were or were not assigned vitamin D supplements, according to researchers.
“These findings suggest a potential structural mechanism for skeletal fragility in [celiac disease] and lay the foundation for further research into the pathogenesis of fracture in this population,” according to researchers. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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