Gluten-free diets can signicantly alter the prognosis of Celiac disease, as one year after beginning a gluten-free diet, a signicant improvement in bone mineral density has been demonstrated.55


children with CD experience a complete catch-up growth in height and weight when put on a gluten free diet. Additionally, Usta, M et al. found a statistically signicant relationship (P0.01) between BMD and compliance to gluten free diet.57


Celiac disease is recognized as “a common secondary cause of metabolic bone disease.” Thus, it is crucial to promptly identify and treat, as any delay in incorporating a gluten-free diet disturbs bone mineral density and increases fracture risk.58


studies have noted a negative impact on bone regeneration and remodeling with the use of bisphosphonate drugs.60


triple increase in the risk of lymphoma, the recommended primary end-point goal for patients with celiac disease is mucosal healing, so as to reduce the risk of lymphoma.


“Celiac disease is often a cause of low bone density and patients with Celiac disease have an increased fracture risk, a hazard ratio of 1.43 or 43% increased risk when compared to age-matched healthy populations.”62


Therapies: In a comparison of studies done by Grace- Farfaglia P., it was evident that adherence to a gluten- free diet “resulted in partial recovery of bone density by one year in all studies, and full recovery by the fth year.”63


study, a gluten free diet has a positive effect on bone mineral density. It was also acknowledged that “sup- plementation with vitamin D and calcium resulted in signicant improvement” in those patients classied as “malnourished.”63


Those with celiac may also benet from vitamin and mineral supplements, as this condition often results in deciencies in important nutrients. However, it is extremely important to remove any sources of gluten, including sometimes unrecognized sources, such as nutritional supplements. Those nutrients, which may be lacking and thus necessitating supplementation include iron, calcium, vitamin D, zinc, copper, folic acid, and other B vitamins to support deciencies. It is advisable to consult with a health care provider to ensure deciencies are addressed,24 sequences.


as to minimize additional health con-


References 1.


http://www.clevelandclinicmeded.com/ medicalpubs/diseasemanagement/gastroenterology/


THE ORIGINAL INTERNIST MARCH 2017 Thus as demonstrated by the above comparison


Interestingly, according to the Columbia University Medical Center’s website, those with celiac disease are at an increased risk of Lymphoma. It was recognized that “patients with celiac disease had an annual lymphoma risk of 67.9 per 100,000,” which is a 2.81-fold increase, compared to the general population risk.61


Given an almost


bone density include the long-term use of anti-resorptive drugs. However use of such drugs has been demonstrated to prevent bone healing and remodeling, and may possibly result in atypical fractures of the femoral neck.59


Other Medical approaches to decreased According to Tau, C, et al.,56


2. Lucnedo AJ, Garcia-Manzanares A. Bone mineral density in adult coeliac disease: An updated review. Rev Esp. Enferm. Dig. 2013 105:154-162.


3. Pantaleoni S, Luchino M, Adriani A, Pellicano R, Stradella D, Ribaldone DG, Sapone N, Isaia GC, Di Stefano M, Astegiano M. Bone Mineral Density at Diagnosis of Celiac Disease and after 1 Year of Gluten-Free Diet. Sci World J. 2014 (2014), Article ID 173082.


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4. Cassella S, anini B, Lanzarotto F, Villanacci V, Ricci C, Lanzini A. Celiac disease in elderly adults: Clinical, serological. And histological characteristics and the effect of a gluten-free diet. J. Am. Geriatr, Soc. 2012 60:1064-1069.


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6. Di Stefano M, Mengoli C, Tomarchio O, Bergonzi M, De Amici M, Ilardo D, Vattiato C, Biagi F, anaboni AM, Miceli E, Corazza GR. P.05.6 High levels of osteoprotegerin and low levels of COOH-terminal propeptide of type I procollagen characterize the persisting bone derangement in celiac disease patients on long-term gluten-free diet. Dig. Dis. 2013 45:S120-S121.


7. Bennett TI, Hunter D, Vaugham JM. Idiopathic steatorrhea. A nutritional disturbance associated with tetany, osteomalacia and anaemia. Q J Med. 1932 1:603-77.


8. Holms WH, Starr P. A nutritional disturbance in adults resembling coeliac disease and sprue: Emaciation, anemia, tetany, chronic diarrhea and malabsorption of fat. JAMA. 1929 92:975-80.


9. Salvesen HA, Boe J. Osteomalacia in sprue. Acta M Scan. 1953 146:290-9.


10. Corazza GR, Di Sario A, Cecchetti L, et al. Inuence of pattern of clinical presentation and of gluten-free diet on bone mass and metabolism in adult coeliac disease. Bone. 1996 18:525-30.


12. Qiao SW, Iversen R, Rki M. et al. The adaptive immune response in celiac disease. Seminars Immunopathol. 2012 34: 523. doi:10.1007/s00281- 012-0314-z.


Szymczak J, Bohdanowicz-Pawlak A, Waszczyk E, Jakubowska J. Low bone mineral density in adult patients with coeliac disease. Endokrynol. Pol. 2012 63:270-276.


11. Mazure R, Vazquez H, Gonzalez D, et al. Bone mineral affection in asymptomatic adult patients with celiac disease. Am J Gastroenterol. 1994 89:2130-4.


13. Celiac Disease and Gluten. Multidisciplinary Challenges and Opportunities. 2014 Elsevier Inc. Eds. Koehler P, Wieser H, Konitzer K. ISBN: 978- 0-12-420220-7.


14. https://celiac.org/live-gluten-free/glutenfreediet/ what-is-gluten/


16. http://www.celiac.com/articles/38/1/How-much- gluten-is-in-a-normal-diet-and-how-much-does-it- take-to-cause-damage-in-a-celiac/Page1.html


15. ht t p: / /www. drgourmet.com/gluten/pdf/ containsgluten.pdf.


17. Catassi C, Fabiani E, Iacono G, D’Agate C, Francavilla R, Biagi F, Volta U, Accomando S, Picarelli A, De Vitis I, Pianelli G, Gesuita R, Carle F, Mandolesi A, Bearzi I, Fasano A. A prospective, (Continued on next page)


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