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Gluten-free diet improves bone parameters in women with celiac disease
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Premenopausal women with celiac disease saw improvements in bone microarchitecture after adhering to a gluten-free diet for 1 year, according to results from a prospective study.
“Celiac disease patients are at high risk for osteopenia, osteoporosis and fragility fractures,” Maria Belen Zanchetta, MD, of the Institute for Diagnostic and Metabolic Research in Buenos Aires, Argentina, told Endocrine Today. “At diagnosis, bone microarchitecture measured by [high-resolution peripheral quantitative CT] was significantly affected in premenopausal women with celiac disease. After 1 year on a gluten-free diet, bone microarchitecture parameters, especially those referring to trabecular bone, improved significantly.”
Zanchetta and colleagues analyzed data from 31 premenopausal women with newly diagnosed celiac disease recruited from a single center in Argentina. Patients were asked to adhere to a gluten-free diet, including at least 1,000 mg per day of calcium through dairy products. Patients completed in-person interviews, food-frequency questionnaires and 48-hour food recalls to assess adherence to the diet; all patients also received vitamin D3 supplementation. Bone microarchitecture parameters were measured at the distal nondominant radius and tibia using high-resolution peripheral quantitative CT (HR-pQCT) at baseline and 1 year; patients underwent areal bone mineral density measurements at the lumber spine, femoral neck and distal radius with DXA at baseline and 1 year.
Researchers also recruited 22 healthy women of similar age and BMI as controls; patients underwent HR-pQCT and DXA scans at baseline only.
Within the celiac disease cohort, 23 were assessed for degree of diet adherence — 16 were considered strictly adherent to the diet; seven were considered partially adherent; and no patients were considered nonadherent.
In assessing measurements at the distal radius at 1 year, researchers found that patients in the celiac disease group saw a mean 9.3% increase in trabecular volumetric density (P < .0001), a mean 9% increase in trabecular/bone volume fraction (P < .0001) and a mean 8.6% increase in trabecular thickness (P = .0004). Cortical thickness decreased by a mean of 3.6% (P = .03).
At the distal tibia, total density increased by a mean of 3.6% (P = .004), trabecular density increased by a mean of 8.3% (P < .0001) and cortical density increased by a mean of 1.54% (P = .0004). Trabecular/bone volume fraction and thickness also increased, by 8.3% and 8.7%, respectively, whereas cortical thickness decreased by 0.8% (P = .05). In the celiac disease group, both BMD and DXA T-score increased at all evaluated regions.
Despite improvements, both volumetric density and bone microarchitecture remained below those of controls, and a prospective, longer-term follow-up of the cohort will assess whether bone microarchitecture can recover completely with a gluten-free diet, according to researchers.
“Future research is needed to know if bone microarchitecture in patients with celiac disease can reach values expected for age,” Zanchetta said. – by Regina Schaffer
For more information:
Maria Belen Zanchetta, MD, can be reached at Libertad 836, P.C. 1012, Buenos Aires, Argentina; email: mzanchetta@idim.com.ar.
Disclosure: Zanchetta reports no relevant financial disclosures.
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