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Calcium absorption and bone mineral density in celiacs after long term treatment with gluten-free diet and adequate calcium intake.

Abstract

Calcium malabsorption, hypocalcemia and skeletal demineralization are well-recognized features of untreated celiac disease. This study investigates calcium absorption and bone mineral density (BMD) after a prolonged, over 4 years, treatment with a gluten-free diet. Twenty-four adult females with treated celiac disease and twenty age- and sex-matched control subjects were studied. Mean body mass index (MBI), energy intake, serum calcium, and serum 25(OH)D concentrations in treated celiacs did not differ from controls. However, while both dietary calcium and protein intake were significantly higher in celiacs (P<0.012), fractional calcium absorption was lower (mean percentage+/-SD; treated 39.8+/-12 versus controls 52.3+/-10, P<0.001). Thus, after adjusting for calcium intake, the estimated amount of calcium absorbed daily was similar in both groups. Whole body, spine and trochanter BMD were significantly lower in treated celiac patients compared with controls (P<0.05). There were significant inverse correlations between: serum parathyroid hormone (PTH) and femoral neck or total body BMD (P<0.01), PTH and duration of gluten-free diet (P=0.05), and fractional calcium absorption and alkaline phosphatase (P=0.022). Increased calcium intake could potentially compensate for the reduced fractional calcium absorption in treated adult celiac patients, but may not normalize the BMD. In addition, the inverse correlation between PTH and time following treatment is suggestive of a continuing long-term benefit of gluten withdrawal on bone metabolism in celiac patients.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Ralston Penn Center, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA. pazianas@mail.med.upenn.edu

    , , , , , , ,

    Source

    MeSH

    Absorption
    Adult
    Aged
    Alkaline Phosphatase
    Bone Density
    Calcium
    Calcium, Dietary
    Case-Control Studies
    Celiac Disease
    Diet, Protein-Restricted
    Female
    Glutens
    Humans
    Middle Aged
    Parathyroid Hormone
    Vitamin D

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    15221205

    Citation

    Pazianas, M, et al. "Calcium Absorption and Bone Mineral Density in Celiacs After Long Term Treatment With Gluten-free Diet and Adequate Calcium Intake." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 16, no. 1, 2005, pp. 56-63.
    Pazianas M, Butcher GP, Subhani JM, et al. Calcium absorption and bone mineral density in celiacs after long term treatment with gluten-free diet and adequate calcium intake. Osteoporos Int. 2005;16(1):56-63.
    Pazianas, M., Butcher, G. P., Subhani, J. M., Finch, P. J., Ang, L., Collins, C., ... Maxwell, J. D. (2005). Calcium absorption and bone mineral density in celiacs after long term treatment with gluten-free diet and adequate calcium intake. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 16(1), pp. 56-63.
    Pazianas M, et al. Calcium Absorption and Bone Mineral Density in Celiacs After Long Term Treatment With Gluten-free Diet and Adequate Calcium Intake. Osteoporos Int. 2005;16(1):56-63. PubMed PMID: 15221205.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Calcium absorption and bone mineral density in celiacs after long term treatment with gluten-free diet and adequate calcium intake. AU - Pazianas,M, AU - Butcher,G P, AU - Subhani,J M, AU - Finch,P J, AU - Ang,L, AU - Collins,C, AU - Heaney,R P, AU - Zaidi,M, AU - Maxwell,J D, Y1 - 2004/06/17/ PY - 2003/07/22/received PY - 2004/03/29/accepted PY - 2004/6/29/pubmed PY - 2005/5/10/medline PY - 2004/6/29/entrez SP - 56 EP - 63 JF - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JO - Osteoporos Int VL - 16 IS - 1 N2 - Calcium malabsorption, hypocalcemia and skeletal demineralization are well-recognized features of untreated celiac disease. This study investigates calcium absorption and bone mineral density (BMD) after a prolonged, over 4 years, treatment with a gluten-free diet. Twenty-four adult females with treated celiac disease and twenty age- and sex-matched control subjects were studied. Mean body mass index (MBI), energy intake, serum calcium, and serum 25(OH)D concentrations in treated celiacs did not differ from controls. However, while both dietary calcium and protein intake were significantly higher in celiacs (P<0.012), fractional calcium absorption was lower (mean percentage+/-SD; treated 39.8+/-12 versus controls 52.3+/-10, P<0.001). Thus, after adjusting for calcium intake, the estimated amount of calcium absorbed daily was similar in both groups. Whole body, spine and trochanter BMD were significantly lower in treated celiac patients compared with controls (P<0.05). There were significant inverse correlations between: serum parathyroid hormone (PTH) and femoral neck or total body BMD (P<0.01), PTH and duration of gluten-free diet (P=0.05), and fractional calcium absorption and alkaline phosphatase (P=0.022). Increased calcium intake could potentially compensate for the reduced fractional calcium absorption in treated adult celiac patients, but may not normalize the BMD. In addition, the inverse correlation between PTH and time following treatment is suggestive of a continuing long-term benefit of gluten withdrawal on bone metabolism in celiac patients. SN - 0937-941X UR - https://www.unboundmedicine.com/medline/citation/15221205/full_citation L2 - https://dx.doi.org/10.1007/s00198-004-1641-2 DB - PRIME DP - Unbound Medicine ER -