%0 Journal Article
%T Bone Mineralization in Celiac Disease
%A Tiziana Larussa
%A Evelina Suraci
%A Immacolata Nazionale
%A Ludovico Abenavoli
%A Maria Imeneo
%A Francesco Luzza
%J Gastroenterology Research and Practice
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/198025
%X Evidence indicates a well-established relationship between low bone mineral density (BMD) and celiac disease (CD), but data on the pathogenesis of bone derangement in this setting are still inconclusive. In patients with symptomatic CD, low BMD appears to be directly related to the intestinal malabsorption. Adherence to a strict gluten-free diet (GFD) will reverse the histological changes in the intestine and also the biochemical evidence of calcium malabsorption, resulting in rapid increase of BMD. Nevertheless, GFD improves BMD but does not normalize it in all patients, even after the recovery of intestinal mucosa. Other mechanisms of bone injury than calcium and vitamin D malabsorption are thought to be involved, such as proinflammatory cytokines, parathyroid function abnormalities, and misbalanced bone remodeling factors, most of all represented by the receptor activator of nuclear factor B/receptor activator of nuclear factor B-ligand/osteoprotegerin system. By means of dual-energy X-ray absorptiometry (DXA), it is now rapid and easy to obtain semiquantitative values of BMD. However, the question is still open about who and when submit to DXA evaluation in CD, in order to estimate risk of fractures. Furthermore, additional information on the role of nutritional supplements and alternative therapies is needed. 1. Epidemiology of Bone Involvement in CD Since 1980s, the most widely used tool in osteoporosis detection, treatment, and follow-up has been dual-energy X-ray absorptiometry (DXA) which showed a strong correlation between detection of bone mineral density (BMD) and fracture risk. Other procedures used to assess BMD include dual-photon absorptiometry (DPA), quantitative computed tomography (QTC), and ultrasound [1]. World Health Organization criteria for osteopenia and osteoporosis are defined by means of BMD as currently assessed by DXA indicating, respectively, a score between £¿1 and £¿2.5 and ¡Ü2.5. Both these conditions consist of a quantitative and qualitative alteration in the arrangement of bone tissue with a consequent increase in bone fragility and susceptibility to fracture [2]. Several studies evaluated bone status in celiac disease (CD), both at diagnosis and after gluten-free diet (GFD), and to date, it has been recognized that bone involvement may be a frequent finding during CD. Nevertheless, studies focusing on the prevalence of bone derangement in celiac patients are still inconclusive since both old and recent findings fall in a wide range ([3, 11], see Table 1). Table 1: Prevalence of low bone mineral density in patients with
%U http://www.hindawi.com/journals/grp/2012/198025/