Abstract
The aim of this study was to perform serological testing to screen for celiac disease (CD) among premenopausal women with idiopathic osteoporosis and to investigate the bone turnover in patients who are seropositive for CD. We studied 89 premenopausal women with idiopathic osteoporosis. The serological screening protocol was based on a two-level evaluation. The first level consisted of determining serum level of IgA antigliadin antibodies (AGA). Subjects who were negative for IgA AGA were classified as not having CD, while samples testing positive for IgA AGA underwent a second level of the screening process. For the second level of screening, the serum IgA endomysial antibody (EMA) test was performed. Bone metabolism was evaluated by serum calcium (Ca), phosphorus, alkaline phosphatase, parathyroid hormone (PTH), 25 (OH) vitamin D, osteocalcin (OC), urinary deoxypyridinoline (dPD), and 24-h urinary calcium levels. Of the 89 patients evaluated, 17 were found to have positive IgA AGA tests (19%) and 9 were found to be positive for EMA (10.11%). EMA-positive patients showed lower values of serum Ca (p<0.05) and 25 (OH) vitamin D (p<0.01) and significantly higher values of PTH (p<0.01) compared with the EMA-negative patients. The level of urinary dPD was found to be significantly higher in EMA-positive patients (p<0.05). The results of this study suggest that all patients with idiopathic osteoporosis should be screened for CD by measurement of EMA. Additionally, we believe that serological screening for CD and detection of such patients will allow determination of the most convenient treatment strategies for osteoporosis.
Similar content being viewed by others
References
Kanis JA, Melton LJ, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141
Raisz LG, Kream BE, Lorenzo JA (1998) Metabolic bone diseases. In: Wilson JD, Foster DW, Kronenbergh HM, Larsen PR (eds) Williams textbook of endocrinology, 9th edn. W.B. Saunders, Philadelphia, pp 1211–1239
Marsh M (1992) Gluten, major histocompatibility complex and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (“celiac sprue”). Gastroenterology 102:330–354
Corazza GR, Di Sario A, Cecchetti L et al (1995) Bone mass and metabolism in patients with celiac disease. Gastroenterology 109:122–128
Kemppainen T, Kroger H, Janatuinen E, et al (1999) Osteoporosis in adult patients with celiac disease. Bone 24:249–255
Hadjivassiliou M, Grunewald RA, Chattopadhyay AK et al (1998) Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia. Lancet 352:1582–1585
Collin P, Vilska S, Heinonen PK et al (1996) Infertility and celiac disease. Gut 39:382–384
Catassi C, Ratsch IM, Fabiani E et al (1994) Coeliac disease in the year 2000: exploring the iceberg. Lancet 343:200–203
Ferguson A, Arranz E, O’Mahony S (1993) Clinical and pathological spectrum of celiac disease-active, silent, latent, potential. Gut 34:150–151
Corazza GR, Frisoni M, Treggiari EA et al (1993) Subclinical coeliac sprue. Increasing occurrence and clues to its diagnosis. J Clin Gastroenterol 16:16–21
Giacci C, Cirillo M, Sollazzo R et al (1995) Gender and clinical presentation of adult celiac disease. Scand J Gastroenterol 30:1077–1081
Vazquez H, Mazure R, Gonzales D et al (2000) Risk of fractures in celiac disease patients: a cross-sectional, case-control study. Am J Gastroenterol 95:183–189
Mazure R, Vazquez H, Gonzales D et al (1994) Bone mineral affection in asymptomatic adult patients with celiac disease. Am J Gastroenterol 89:2130–2134
Cellier C, Flobert C, Cormier C et al (2000) Severe osteopenia in symptom-free adults with a childhood diagnosis of coeliac disease. Lancet 355:806
Mustalahti K, Collin P, Sievanen H et al (1999) Osteopenia in patients with clinically silent celiac disease warrant screening. Lancet 28:744–745
Lindh E, Ljunghall S, Larson K et al (1992) Screening for antibodies against gliadin in patients with osteoporosis. J Int Med 231:1403–1406
Maki M (1995) The humoral immune system in celiac disease. Baillieres Clin Gastroenterol 9:231–249
Kelly TL (1990) Bone mineral density reference databases for American men and women. J Bone Miner Res 5:5249
Vogelsang H, Genser D, Wyatt J et al (1995) Screening for celiac disease: a prospective study on the value of non-invasive tests. Am J Gastroenterol 90:394–398
Carroccio A, Iacono G, Montalto G (1993) Immunologic and absorptive tests in celiac disease: can they replace intestinal biopsies? Scand J Gastroenterol 28:673–676
Rostami K, Kerchaert J, Tiemessen R et al (1999) Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease: disappointing in clinical practice. Am J Gastroenterol 94:888–894
Ferreira M, Davies SL, Butler M et al (1992) Endomysial antibody: is it the best screening test for celiac disease? Gut 33:1633–1637
Grodzinsky E, Hed J, Skogh T (1994) IgA antiendomysium antibodies have a high positive predictive value for celiac disease in asymptomatic patients. Allergy 38:2034–2037
Hallert C, Astrom J (1982) Psychic disturbances in adult celiac disease. II. Physiological findings. Scand J Gastroenterol 17:21–24
Nuti R, Martini G Valenti R et al (2001) Prevalence of undiagnosed celiac syndrome in osteoporotic women. J Int Med 250:361–366
Gonzales D, Sugai E, Gomez JC et al (2002) Is it necessary to screen for celiac disease in postmenopausal osteoporotic women? Calcif Tissue Int 71:141–144
Keaveny AP, Freaney R, McKenna MJ et al (1996) Bone remodeling indices and secondary hyperparathyroidism in celiac disease. Am J Gastroenterol 91:1226–1231
Gannage MH, Abikaram G, Nasr F et al (1998) Osteomalacia secondary to celiac disease, primary hyperparathyroidism and Graves’ disease. Am J Med Sci 315:136–139
Selby PY, Davies M, Adams JE et al (1999) Bone loss is related to secondary hyperparathyroidism. J Bone Miner Res 14:652–657
Forneri MC, Pedreira S, Nibeloni S et al (1998) Pre- and post-treatment serum levels of cytokines IL-I beta, IL-6, and IL-I receptor antagonist in celiac disease. Are they related to the associated osteopenia? Am J Gastroenterol 93:413–418
Farrell RJ, Kelly CP (2001) Diagnosis of celiac sprue. Am J Gastroenterol 96:3227–3246
Fasano A (1996) Where have all the American celiacs gone? Acta Paediatr 85:20–24
Johnston SD, Watson RGP, McMillian SA et al (1997) Prevalence of celiac disease in Northern Ireland. Lancet 350:1370
Logan R (1996) Screening for celiac disease-has the time come for mass screening? Acta Paediatr 412:49–51
Feighery C, Weir DG, Whelan A et al (1998) Diagnosis of gluten sensitive enteropathy: is exclusive reliance on histology appropriate? Eur J Gastroenterol Hepatol 10:919–935
Rossi TM, Kumar V, Lerner A et al (1988) Relationship of endomysial antibodies to jejunal mucosal pathology: specificity towards both symptomatic and asymptomatic celiacs. J Pediatr Gastroenterol Nutr 7:858–863
Trier JS (1991) Celiac sprue. N Engl J Med 325:1709–1719
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Armagan, O., Uz, T., Tascioglu, F. et al. Serological screening for celiac disease in premenopausal women with idiopathic osteoporosis. Clin Rheumatol 24, 239–243 (2005). https://doi.org/10.1007/s10067-004-1011-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-004-1011-7