Celiac disease and bone health

Abstract

Celiac disease is an autoimmune disorder with genetic and environmental components. The prevalence of the disease is about 1 % in many parts of the world. It is characterized by innate and adaptive immune responses that are primarily triggered by the ingestion of dietary gluten, resulting in inflammation, villous atrophy, and crypt hyperplasia in the small intestine. Genes that code for human leukocyte antigens (HLA) DQ2 and DQ8 are strongly associated with and confer susceptibility for celiac disease. In addition to the characteristic intestinal symptoms, celiac disease is associated with extra-intestinal complications, including those affecting skeletal health. Reduction in bone mineral density and increased risk of bone fracture, caused by malabsorption-related alteration of calcium metabolism and immune-mediated mechanisms, are frequently seen in patients with celiac disease. The diagnosis of celiac disease relies on serologic testing and intestinal biopsy. Bone density evaluation is recommended within 1 year of diagnosis and treatment. Gluten-free diet is the recommended treatment for celiac disease, usually resulting in the gradual recovery of intestinal mucosa, which leads to elimination of calcium and vitamin deficiencies and progression towards normalization of bone density. This chapter summarizes the currently available information regarding the prevalence, pathogenic mechanism, and treatment of celiac disease in the context of bone health.