Impact of a gluten-free diet on bone mineral density in celiac patients.

BACKGROUND Osteoporosis (OP) is a metabolic bone illness that may complicate celiac disease (CD). It can lead to devastating consequences because of low bone mass and fragility fractures. PURPOSE To study the OP prevalence in a group of Brazilian patients with CD and the value of a gluten free diet (GFD). METHODS Retrospective study of celiac female patients from a single University Center followed with bone densitometries. Results from densitometry made at first visit were compared with a second study after a median time of 5 years. During this period, patients were submitted to a GFD according to orientations from special program training. Calcium and vitamin D were prescribed to those patients who did not reach the minimal daily requirement through diet. RESULTS Forty-one celiac female patients, mean age 46.1 ± 14.8 years, were included. The prevalence of osteopenia at first visit was 56.1% and that of osteoporosis 29.2%. Osteoporosis was associated with longer disease duration (p = 0.01). The second densitometry was performed in a median time of 5 years (range 1 to 13 years) and disclosed 58.9% osteopenia and 28.2% osteoporosis. The GFD improved bone mass, mainly at (of) spine (comparison of T score with p = 0.03 and of bone mass in g/cm2 with p = 0.02), but it was not sufficient to reduce the number of osteopenic (p = 0.9) and osteoporotic patients (p = 0.4). During the follow up period 25% of osteoporotic patients developed low impact fractures. CONCLUSION Bone health is notably impaired at baseline in CD patients, especially in those with a diagnostic delay. A GFD modestly improved bone mass density with low impact fractures occurring in one third of patients during the follow up period.