Risk Factors for Decreased Bone Density in Adults with Celiac Disease

Background: Celiac disease (CD) is an autoimmune disease characterized by inflammation in the intestine, causing atrophy of the mucosal villi of the small intestine. Celiac disease can manifest with various signs and symptoms, including extra-intestinal symptoms such as osteopenia and osteoporosis. Objectives: Our study aimed to determine the frequency of osteopenia/osteoporosis in newly diagnosed CD cases and to evaluate the effect of different independent variables on the development of osteopenia/osteoporosis in these patients. Methods: Adult patients with CD who were referred to a celiac clinic were evaluated for osteopenia/osteoporosis using dual-energy X-ray absorptiometry. This cross-sectional analytical study took place from October 2017 to July 2022. Logistic regression analysis was used to assess the odds ratio (OR) of different independent variables for osteopenia/osteoporosis. Results: A total of 302 patients enrolled in this study, with 64.2% being female and 35.8% male. The mean ± SD age was 29.73 ± 12.39. Overall, 71.2% of patients had osteopenia or osteoporosis. The odds of developing osteopenia/osteoporosis were significantly higher in participants older than 30 years (OR: 2.19; 95% CI: 1.22 - 3.92; P = 0.008), underweight patients (OR: 2.38; 95% CI: 1.30 - 4.34; P = 0.005), and those with histologically severe atrophy (OR: 2.22; 95% CI: 1.14 - 4.32; P = 0.019). The mean ± SD serum levels of 25-hydroxy vitamin D in CD patients without and with osteopenia/osteoporosis were 34.0 ± 17.1 ng/mL and 25.8 ± 14.2 ng/mL, respectively. Participants with normal levels of 25-hydroxy vitamin D had a significantly lower OR of developing osteopenia/osteoporosis than patients with vitamin D deficiency (OR: 0.37; 95% CI: 0.21 - 0.62; P < 0.001). Other variables, including gender, anti-tTG levels, and GI manifestations, did not significantly increase the OR of developing osteopenia/osteoporosis. Conclusions: The present study showed that increasing age, weight loss, severe villous atrophy, and low levels of vitamin D can significantly increase the OR of developing osteopenia/osteoporosis in CD patients. Until further studies are conducted, bone mineral density (BMD) evaluation is especially recommended in these high-risk subgroups of CD patients.