CD: Bone Density (2006)
What is the long-term effectiveness in people with celiac disease of following a gluten-free dietary pattern on bone density?
Clinical trials and cross-sectional studies have reported reduced bone mineral content and bone mineral density in untreated children, adolescents and adults with celiac disease; both of these parameters improve significantly with compliance to a gluten-free dietary pattern for at least 1 year. Compliance with dietary treatment initiated during childhood or adolescence allows achievement of a normal bone mineralization. However, studies in untreated adults have shown that a gluten-free dietary pattern improves but may not normalize bone mineral density; successful treatment depends on the age at diagnosis, as patients who do not receive treatment in childhood and adolescence may never reach peak bone mass. Further studies are needed regarding the effects of calcium and vitamin D supplementation on bone mineral content and bone mineral density, as well as hormone replacement therapy for postmenopausal women.
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
Evidence Summary: What is the long-term effectiveness of following a gluten-free dietary pattern on bone density?
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Bai JC, Gonzalez D, Mautalen C, Mazure R, Pedreira S, Vazquez H, Smecuol E, Siccardi A, Cataldi M, Niveloni S, Boerr LA, Maurino E. Long-term effect of gluten restriction on bone mineral density of patients with celiac disease. Aliment Pharmacol Ther. 1997;11:157-164.
- Bardella MT, Fredella C, Prampolini L, Molteni N, Giunta AM, Bianchi PA. Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten-free diet. Am J Clin Nutr. 2000; 72: 937-939.
- Barera G, Beccio S, Proverbio MC, Mora S. Longitudinal changes in bone metabolism and bone mineral content in children with celiac disease during consumption of a gluten-free diet. Am J Clin Nutr. 2004; 79: 148-154.
- Carbone MC, Pitzalis G, Ferri M, Nenna R, Thanasi E, Andreoli A, De Lorenzo A, Bonamico M. Body composition in coeliac disease adolescents on a gluten-free diet: a longitudinal study. Acta Diabetol 2003; 40: S171-173.
- Ciacci C, Maurelli L, Klain M, Savino G, Salvatore M, Mazzacca G, Cirillo M. Effect of dietary treatment on bone mineral density in adults with celiac disease: factors predicting response. Am J Gastroenterology 1997; 92(6): 992-996.
- Corazza GR, Di Sario A, Cecchetti L, Tarozzi C, Corrao G, Bernardi M, Gasbarrini G. Bone mass and metabolism in patients with celiac disease. Gastroenterology 1995; 109(1): 122-128.
- Corazza GR, Di Sario A, Cecchetti L, Jorizzo RA, Di Stefano M, Minguzzi L, Brusco G, Bernardi M, Gasbarrini G. Influence of pattern of clinical presentation and of gluten-free diet on bone mass and metabolism in adult celiac disease. Bone 1996; 18(6): 525-530.
- De Lorenzo A, Di Campli C, Andreoli A, Sasso GF, Bonamico M, Gasbarrini A. Assessment of body composition by bioelectrical impedance in adolescent patients with celiac disease. Am J Gastroenterol 1999 Oct; 94(10): 2951-2955.
- Kalayci AG, Kansu A, Girgin N, Kucuk O, Aras G. Bone mineral density and importance of a gluten-free diet in patients with celiac disease in childhood. Pediatrics 2001; 108(5): E89.
- Kavak US, Yuce A, Kocak N, Demir H, Saltik IN, Gurakan F, Ozen H. Bone mineral density in children with untreated and treated celiac disease. J Pediatr Gastroenterol Nutr 2003 Oct; 37(4): 434-436.
- Kemppainen T, Kroger H, Janatuinen E, Arnala I, Lamberg-Allardt C, Karkkainen M, Kosma VM, Julkunen R, Jurvelin J, Alhava E, Uusitupa M. Bone recovery after a gluten-free diet: a 5-year follow-up study. Bone 1999; 25: 355-360.
- McFarlane XA, Bhalla AK, Reeves DE, Morgan LM, Robertson DAF. Osteoporosis in treated adult celiac disease. Gut 1995; 36: 710-714.
- McFarlane XA, Bhalla AK, Robertson DAF. Effect of a gluten-free diet on osteopenia in adults with newly diagnosed celiac disease. Gut 1996; 39: 180-184.
- Molteni N, Bardella MT, Vezzoli G, Pozzoli E, Bianchi P. Intestinal calcium absorption as shown by stable strontium test in celiac disease before and after gluten-free diet. Am J Gastroenterol 1995; 90: 2025-2028.
- Mora S, Barera G, Ricotti A, Weber G, Bianchi C, Chiumello G. Reversal of low bone density with a gluten-free diet in children and adolescents with celiac disease. Am J Clin Nutr 1998; 67: 477-481.
- Mora S, Barera G, Beccio S, Proverbio MC, Weber G, Bianchi C, Chiumello G. Bone density and bone metabolism are normal after long-term gluten-free diet in young celiac patients. Am J Gastroenterol 1999; 94: 398-403.
- Mora S, Barera G, Beccio S, Menni L, Proverbio MC, Bianchi C, Chiumello G. A prospective, longitudinal study of the long-term effect of treatment on bone density in children with celiac disease. J Pediatr 2001; 139: 516-521.
- O'Leary C, Wieneke P, Healy M, Cronin C, O'Regan P, Shanahan F. Celiac disease and the transition from childhood to adulthood: a 28-year follow up. Am J Gastroenterol 2004; 99:2437-2441.
- Pistorius LR, Sweidan WH, Purdie DW, Steel SA, Howey S, Bennett JR, Sutton DR. Celiac disease and bone mineral density in adult female patients. Gut 1995; 37: 639-642.
- Rea F, Polito C, Marotta A, Di Toro A, Iovene A, Collini R, Rea L, Sessa G. Restoration of body composition in celiac children after one year of gluten-free diet. J of Pediatric Gastroenterology and Nutrition 1996; 23: 408-412.
- Sategna-Guidetti C, Grosso SB, Grosso S, Mengozzi G, Aimo G, Zaccaria T, Di Stefano M, Isaia GC. The effects of 1-year gluten withdrawal on bone mass, bone metabolism and nutritional status in newly diagnosed adult celiac disease patients. Aliment Pharmacol Ther 2000; 14: 35-43.
- Scotta MS, Salvatore S, Salvatoni A, De Amici M, Ghiringhelli D, Broggini M, Nespoli L. Bone mineralization and body composition in young patients with celiac disease. Am J Gastroenterol 1997 Aug; 92(8): 1331-1334.
- Sdepanian VL, de Miranda Carvalho CN, de Morais MB, Colugnati FAB, Fagundes-Neto U. Bone mineral density of the lumbar spine in children and adolescents with celiac disease on a gluten-free diet in Sao Paulo, Brazil. J Pediatr Gastroenterol Nutr 2003 Nov; 37(5): 571-576.
- Szathmari M, Tulassay T, Arato A, Bodanszky H, Szabo A, Tulassay Z. Bone mineral content and density in asymptomatic children with coeliac disease on a gluten-free diet. Eur J Gastroenterol Hepatol 2001; 13(4): 419-424.
- Valdimarsson T, Lofman O, Toss G, Strom M. Reversal of osteopenia with diet in adult celiac disease. Gut 1996; 38: 322-327.
- Valdimarsson T, Toss G, Lofman O, Strom M. Three years' follow-up of bone density in adult coeliac disease: significance of secondary hyperparathyroidism. Scand J Gastroenterol 2000; 35(3): 274-280.
- Vazquez H, Mazure R, Gonzalez D, Flores D, Pedreira S, Niveloni S, Smecuol E, Maurino E, Bai JC. Risk of fractures in celiac disease patients: a cross-sectional, case-control study. Am J Gastroenterol 2000; 95(1): 183-189.
- Walters JR, Banks LM, Butcher GP, Fowler CR. Detection of low bone mineral density by dual energy x ray absorptiometry in unsuspected suboptimally treated celiac disease. Gut 1995; 37(2):220-224.
Search Plan and Results: CD: Bone Density 2007