262 - Utility of biochemical markers of bone remodeling in adult patients with celiac disease
Autor(s): G. Bonetti, F. Pagani, F. Lanzarotto, M. Panteghini
Issue: RIMeL - IJLaM, Vol. 3, N. 4, 2007 (MAF Servizi srl ed.)
Page(s): 262-298
Objective. Modification of physiological bone remodeling is present with high frequency in adult patients with celiac disease. Aim of this study was to evaluate biochemical markers of bone remodeling (BMBR) in a group of adult patients with celiac disease. Materials and methods. Markers of bone formation as bone specific alcaline phosphatase (BALP) and osteocalcin (OC) and markers of bone resorption as urinary free deoxypyridinoline (U-DPD) and urinary Ntelopeptide of type I collagen (U-NTX-I), were determined at diagnosis and after 1-year on gluten-free diet. 139 patients, 37 males (20-58 years old) and 102 females (17-72 years old) were included. Bone mineral density (BMD) was evaluated in 53 newly diagnosed patients by dual-energy X-ray absorptiometry (DEXA) at femoral neck. BMD was expressed as T score (i.e., number of SDs from the mean of young adult healthy population, corresponding to peak bone mass, comparable for gender and race). Results. Using World Health Organization criteria for bone densitometry, 3 patients were classified as having osteoporosis, 26 patients osteopenia and 24 patients normal bone mass. All osteoporotic patients had BMBR above the upper reference limits (URL); in osteopenic patients and in those without any densitometry abnormality high values of BALP in 27% and 33%, of OC in 69% and 71%, of U-DPD in 72% and 58%, of U-NTX-I in 50% and 30% were found, respectively. A significant reduction (p<0.001) of all BMBR was noted in patients (n=126) after 1-year on gluten-free diet, however, in 43 patients (34%) BMBR remained above the URL. Discussion and conclusions. The evaluation of BMBR in newly diagnosed celiac patients can show the presence of changes in bone remodeling even without any modification of bone densitometry. The statistically significant reduction of BMBR after 1-year of gluten-free diet demonstrates that diet is good to control bone disease. Otherwise the presence of high values of BMBR after the diet can indicate the need of a revaluation to begin therapy with inhibitors of bone resorption.