Introduction The optimal timing for performing a baseline bone mineral density (BMD) in Coeliac disease (CD) patients is controversial. European guidelines published in 1998 recommended a baseline BMD at diagnosis. One study in 2005 demonstrated a low incidence of BMD abnormalities amongst patients with CD1 and the British Society of Gastroenterology guidelines state that DEXA should only be done after introduction of a gluten-free diet on the subgroups of patients in whom the risk of osteoporotic fracture is high2. This was however followed up by a guidance document in 2010 stating that BMD assessment should always be performed at diagnosis. Meanwhile the American guidelines suggest testing for vitamin and micronutrient deficiencies3. The aims of this study were to determine, the prevalence of osteopenia and osteoporosis among patients who are newly diagnosed with CD, and any risk factors which would increase patients' risk of osteopenia and osteoporosis.
Methods We carried out a prospective cohort study, where newly diagnosed CD patients were recruited. DEXA scanning was done at diagnosis. Data with regards to smoking, BMD and histology was entered into a database and analysed using SPSS software package.
Results 137 patients with a histological diagnosis of CD were recruited. 76.6% were females. Mean age at diagnosis was 37.1 years (95% CI: ±3.19 years). 21.9% (n = 30) of patients were osteoporotic and another 51.1% (n = 72) were osteopenic at diagnosis. A total of 14.9% (n = 17) had a previous history of fracture/s prior to diagnosis. Osteoporosis at the spine was significantly associated with the female gender (p = 0.04) and with an older age at diagnosis (50.3 years p = 0.01; 95% CI: ±6.6 years). Patients with Marsh 3c disease at diagnosis were also more likely to have an abnormal BMD at the spine than patients with Marsh 3a or 3b (p = 0.04). Mean BMI between osteopenic (24.15 kg/m2 95% CI: ±1.29) and osteoporotic (23.37 kg/m2 95% CI: ±2.81) patients was slightly different but not statistically significant (p = 0.07).
Conclusion This data demonstrates a high rate of osteopenia and osteoporosis among CD patients at diagnosis. DEXA scanning should therefore be considered at diagnosis. This is of greater importance in female patients diagnosed at or above the age of 50 years and with Marsh 3c disease.
Lewis NR, Scott BB. Should patients with coeliac disease have their bone mineral density measured? Eur J Gastroenterol Hepatol 2005 Oct;17(10):1065–70
NR Lewis, BB Scott. Guidelines for osteoporosis in inflammatory bowel disease and coeliac disease. British Society of Gastroenterology June 2007
American Gastroenterological Association medical position statement: Guidelines on osteoporosis in gastrointestinal diseases. Gastroenterology - March 2003;124(3): 791–794)
Disclosure of Interest None Declared.