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Bone Mineralization in Young Patients with Type 1 Diabetes Mellitus and Screening-identified Evidence of Celiac Disease

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Abstract

The aims of this study were to evaluate bone mineral density (BMD) and bone turnover markers in patients with type 1 diabetes and screening-identified evidence of celiac disease, i.e., celiac autoimmunity. We screened 50 consecutive type 1 diabetic patients for IgA antitissue transglutaminase to identify those with celiac autoimmunity. Eight seropositive patients were identified on this screening, and 12 patients matched for gender and age range were selected as a control group from among the type 1 diabetic patients without celiac autoimmunity. Patients and controls underwent dual-energy X-ray absorptiometry (DEXA) for measurement of bone mineral status and had their blood levels of osteocalcin, carboxy-terminal telopeptide of type I collagen (CTX), calcium, and phosphorus determined. BMD was further adjusted for height, weight, and pubertal stage. Radiographic and blood markers of bone mineralization were compared between patients and controls. BMD (Z-score) at the lumbar spine was −1.44 ± 0.5 SD for patients and 0.04 ± 0.2 SD for controls (P = 0.02). Bone mineral content was 37.9 ± 4.5 g for patients and 49.4 ± 2.6 g for controls (P = 0.049). Adjusted BMD was −0.62 ± 0.5 SD for patients and 0.81 ± 0.09 SD for controls (P = 0.04). After adjustment, four patients and none of the controls presented BMD < −1 SD (P = 0.01). Osteocalcin, CTX, calcium, and phosphorus blood levels were not significantly different between patients and controls. Celiac autoimmunity is associated with reduced bone mineralization in type 1 diabetic patients. The pathophysiological mechanisms and clinical relevance of this finding remain to be further investigated.

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Abbreviations

BMD:

Bone mineral density

BMC:

Bone mineral content

CD:

Celiac disease

CTX:

Carboxy-terminal telopeptide of type I collagen

DEXA:

Dual-energy X-ray absorptiometry

NS:

Nonsignificant

SD:

Standard deviation

SEM:

Standard error of the mean

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Acknowledgements

This study was supported by a grant from the Research Foundation of Bahia (FAPESB). Dr. Diniz-Santos receives financial support from FAPESB.

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology and Hepatology, Hosannah de Oliveira Pediatric Center, Federal University of Bahia, Av. Princesa Isabel, 549, Apt. 11. Barra Avenida, CEP 40130-030, Salvador, Bahia, Brazil

    Daniel R. Diniz-Santos & Luciana R. Silva

  2. Pediatric Unit, State of Bahia Center for Diabetes and Endocrinology (CEDEBA), Salvador, Brazil

    Flávia Brandão & Luis Adan

  3. Department of Pediatrics, School of Medicine, Federal University of Bahia, Salvador, Brazil

    Luis Adan & Luciana R. Silva

  4. LPC Clinical Pathology Laboratory, Salvador, Brazil

    Agnaluce Moreira

  5. Bone Densitometry Unit, Vida Clinics, Salvador, Brazil

    Eliézer J. Vicente

Authors
  1. Daniel R. Diniz-Santos
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  2. Flávia Brandão
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  3. Luis Adan
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  4. Agnaluce Moreira
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  5. Eliézer J. Vicente
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  6. Luciana R. Silva
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Correspondence to Daniel R. Diniz-Santos.

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Diniz-Santos, D.R., Brandão, F., Adan, L. et al. Bone Mineralization in Young Patients with Type 1 Diabetes Mellitus and Screening-identified Evidence of Celiac Disease. Dig Dis Sci 53, 1240–1245 (2008). https://doi.org/10.1007/s10620-007-9988-9

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  • DOI: https://doi.org/10.1007/s10620-007-9988-9

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