Impaired Bone Microarchitecture Improves After One Year On Gluten‐Free Diet: A Prospective Longitudinal HRpQCT Study in Women With Celiac Disease

Journal of Bone and Mineral Research

Jan 2017

DOI: 10.1002/jbmr.2922

Citations:49

Influential Citations:2

Observational Studies (Human)

Enhanced Details

Methods

Prospective, longitudinal study in premenopausal women with newly diagnosed celiac disease. 31 consecutive participants enrolled; 26 reassessed after 1 year on gluten-free diet. Measurements included HRpQCT at distal radius and tibia, areal BMD by DXA, and biochemical tests. Healthy control group: 22 premenopausal women with similar age and BMI for baseline comparison.

Intervention

Gluten-free diet plus calcium intake ~1000 mg/day via dairy products and vitamin D3 supplementation with baseline-guided dosing: 0–9.9 ng/mL 25OHD → 400,000 IU total across four doses every 15 days; 10–19.9 ng/mL → 200,000 IU across two doses; 20–29.9 ng/mL → 100,000 IU as a single dose. After 3 months, 25OHD recheck; if >30 ng/mL, maintenance 100,000 IU every 3 months; if not, dose adjusted. 25OHD measured again at 1 year. Vitamin D supplementation given to all; dairy calcium ~1000 mg/day. 12-month follow-up.

Results

After 12 months on gluten-free diet with calcium and vitamin D, trabecular bone microarchitecture improved in distal radius and tibia (trabecular density/BV/TV/ Tb.Th increased by about 8–9%), trabecular number remained stable, and cortical density increased in tibia while cortical thickness decreased at both sites. Areal BMD by DXA increased across the lumbar spine, femoral neck, distal radius, and total hip by roughly 2.5–3.7%. Most parameters remained lower than healthy controls, indicating partial recovery. Greater improvements occurred in those with lower baseline 25OHD and in those whose celiac disease antibodies became negative; changes in anti-tTG IgA correlated with microarchitectural gains, while 25OHD changes did not independently predict improvements. Conclude that gluten-free diet plus calcium and vitamin D yields meaningful bone recovery, but full normalization to age-matched controls may require longer follow-up.

Limitations

Small sample size (26 completing 1-year follow-up); single-center; HR-pQCT limited (no cortical porosity or finite element analysis); potential confounding by vitamin D supplementation; control group recruited from staff/relatives of osteoporosis clinic; adherence variability to gluten-free diet; some CD antibodies remained nonnegative after 1 year.

Abstract

We have recently identified a significant deterioration of bone microarchitecture in premenopausal women with newly diagnosed celiac disease (CD) using high‐resolution peripheral quantitative computed tomography (HRpQCT). The aim of this work was to assess changes in bone microarchitecture after 1 year on a gluten‐free diet (GFD) in a cohort of premenopausal women. We prospectively enrolled 31 consecutive females at diagnosis of CD; 26 of them were reassessed 1 year after GFD. They all underwent HRpQCT scans of distal radius and tibia, areal BMD by DXA, and biochemical tests (bone‐specific parameters and CD serology) at both time points. Secondary, we compared 1‐year results with those of a control group of healthy premenopausal women of similar age and BMI in order to assess whether the microarchitectural parameters of treated CD patients had reached the values expected for their age. Compared with baseline, the trabecular compartment in the distal radius and tibia improved significantly (trabecular density, trabecular/bone volume fraction [BV/TV] [p < 0.0001], and trabecular thickness [p = 0.0004]). Trabecular number remained stable in both regions. Cortical density increased only in the tibia (p = 0.0004). Cortical thickness decreased significantly in both sites (radius: p = 0.03; tibia: p = 0.05). DXA increased in all regions (lumbar spine [LS], p = 0.01; femoral neck [FN], p = 0.009; ultradistal [UD] radius, p = 0.001). Most parameters continued to be significantly lower than those of healthy controls. This prospective HRpQCT study showed that most trabecular parameters altered at CD diagnosis improved significantly by specific treatment (GFD) and calcium and vitamin D supplementation. However, there were still significant differences with a control group of women of similar age and BMI. In the prospective follow‐up of this group of patients we expect to be able to assess whether bone microarchitecture attains levels expected for their age. © 2016 American Society for Bone and Mineral Research. show less