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Predictors of improvement in bone mineral density after celiac disease diagnosis

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Low bone density is frequently found in patients newly diagnosed with celiac disease (CD), and improvement is variable. This study was performed to assess changes in bone mineral density (BMD) by dual x-ray absorptiometry (DXA) at the lumbar spine, hip, and distal one-third radius as well as clinical predictors of BMD changes after the diagnosis and treatment of CD.


Adult CD patients who had serial DXA at the Celiac Disease Center at Columbia University Medical Center were included (N = 103). We assessed within-person changes in BMD with paired t-tests. Multiple regression was utilized to assess baseline clinical and laboratory predictors of BMD improvement after diagnosis and treatment.


The mean age of our sample was 45.6 years (±SD 15.1) and 60% were female. After a median follow-up of 21 months, lumbar spine BMD increased by 1.7 ± 5.5% (p = 0.006) after CD diagnosis. There was a similar trend at the total hip (1.6 ± 6.3%, p = 0.06), but no change at the femoral neck or distal one-third radius. Lower baseline serum calcium predicted a greater increase in lumber spine BMD (ß = −0.0470 g/cm2, p = 0.002). At the hip, higher baseline creatinine clearance (ß = 0.005, p = 0.02) was associated with greater gains in BMD.


BMD increases at the lumbar spine after the diagnosis of CD and greater BMD improvement is associated with lower baseline serum calcium. This suggests that those with the lowest calcium, which is likely a surrogate for the greatest malabsorption, may have the greatest potential for improvement in skeletal health after treatment of CD.

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Fig. 1

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Bone mineral density


Celiac disease


Columbia University Medical Center


Dual x-ray absorptiometry


Lumber spine


Parathyroid hormone


Total hip


Tissue transglutaminase.


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Author Contributions

Study concept and design: H.M.Z., B.L., M.D.W., P.H.R.G. Acquisition of data: H.M.Z., B.L., M.D.W. Analysis and interpretation of data: H.M.Z., B.L., A.R., M.D.W., P.H.R.G. Drafting of the manuscript: H.M.Z., B.L., M.D.W., P.H.R.G. Critical revision of the manuscript for important intellectual content: H.M.Z., B.L., A.R., M.D.W., P.H.R.G. Statistical analysis: A.R. Study supervision: P.H.R.G.

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Correspondence to Peter H. R. Green.

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The authors declare that they have no competing interests.

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This analysis was approved by the Institutional Review Board of Columbia University (IRB-AAAR0254).

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Zylberberg, H.M., Lebwohl, B., RoyChoudhury, A. et al. Predictors of improvement in bone mineral density after celiac disease diagnosis. Endocrine 59, 311–318 (2018).

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