Bone remodeling indices and secondary hyperparathyroidism in celiac disease

A. P. Keaveny, R. Freaney, M. J. McKenna, J. Masterson, D. P. O'Donoghue

Research output: Contribution to journalArticle

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Abstract

Objectives: to determine the prevalence of hypovitaminosis D and secondary hyperparathyroidism (SHPT) and to assess bone turnover by using markers of bone formation and resorption in celiac disease (CD). Methods: Forty-three patients with CD were investigated: group 1, newly diagnosed celiacs (n = 19); group 2, treated celiacs responding histologically to a gluten-free diet (n = 16); group 3, refractory celiacs, unresponsive to a gluten-free diet and immunosuppressive therapy (n = 8). Serum was drawn for intact parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D], ionized calcium (Cai), total alkaline phosphatase (AP), and biochemical markers of bone formation: procollagen I carboxyterminal propeptide (PICP) and osteocalcin (Oc). Urinary indices of bone resorption, deoxypyridinoline (DPD), pyridinoline (PyD), and hydroxyproline (OHP), were measured in a 2-h fasting urine. In 22 patients, computerized tomographic scan for bone mineral density (BMD) was performed. Results: The prevalence in groups 1, 2, and 3, respectively, of hypovitaminosis D (<50 nmol/L) was 58%, 25%, and 88%, and the prevalence of SHPT (>5.4 pmol/L) was 25%, 19%, and 25%. Bone resorption markers were significantly elevated in all groups, and bone formation indices were elevated in the newly diagnosed celiacs compared with a group of healthy adults. Low BMD (T-score greater than -1 SD unit) was found in 68% of patients assessed; 36% of patients had a T-score greater than -2.5 SD units. Conclusions: Hypovitaminosis D and SHPT are common in newly diagnosed and refractory celiacs but are less common in those who respond to a gluten-free diet. Newly diagnosed patients have a high bone turnover state with elevation of both bone formation and resorption indices. Those with refractory disease demonstrate a remodeling imbalance with high bone resorption.

Original languageEnglish (US)
Pages (from-to)1226-1231
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume91
Issue number6
StatePublished - Jun 1996
Externally publishedYes

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Secondary Hyperparathyroidism
Bone Remodeling
Celiac Disease
Bone Resorption
Abdomen
Osteogenesis
Gluten-Free Diet
Bone Density
Diet Therapy
Procollagen
Hydroxyproline
Osteocalcin
Immunosuppressive Agents
Parathyroid Hormone
Alkaline Phosphatase
Fasting
Biomarkers
Urine
Calcium
Serum

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Keaveny, A. P., Freaney, R., McKenna, M. J., Masterson, J., & O'Donoghue, D. P. (1996). Bone remodeling indices and secondary hyperparathyroidism in celiac disease. American Journal of Gastroenterology, 91(6), 1226-1231.

Bone remodeling indices and secondary hyperparathyroidism in celiac disease. / Keaveny, A. P.; Freaney, R.; McKenna, M. J.; Masterson, J.; O'Donoghue, D. P.

In: American Journal of Gastroenterology, Vol. 91, No. 6, 06.1996, p. 1226-1231.

Research output: Contribution to journalArticle

Keaveny, AP, Freaney, R, McKenna, MJ, Masterson, J & O'Donoghue, DP 1996, 'Bone remodeling indices and secondary hyperparathyroidism in celiac disease', American Journal of Gastroenterology, vol. 91, no. 6, pp. 1226-1231.
Keaveny AP, Freaney R, McKenna MJ, Masterson J, O'Donoghue DP. Bone remodeling indices and secondary hyperparathyroidism in celiac disease. American Journal of Gastroenterology. 1996 Jun;91(6):1226-1231.
Keaveny, A. P. ; Freaney, R. ; McKenna, M. J. ; Masterson, J. ; O'Donoghue, D. P. / Bone remodeling indices and secondary hyperparathyroidism in celiac disease. In: American Journal of Gastroenterology. 1996 ; Vol. 91, No. 6. pp. 1226-1231.
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abstract = "Objectives: to determine the prevalence of hypovitaminosis D and secondary hyperparathyroidism (SHPT) and to assess bone turnover by using markers of bone formation and resorption in celiac disease (CD). Methods: Forty-three patients with CD were investigated: group 1, newly diagnosed celiacs (n = 19); group 2, treated celiacs responding histologically to a gluten-free diet (n = 16); group 3, refractory celiacs, unresponsive to a gluten-free diet and immunosuppressive therapy (n = 8). Serum was drawn for intact parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D], ionized calcium (Cai), total alkaline phosphatase (AP), and biochemical markers of bone formation: procollagen I carboxyterminal propeptide (PICP) and osteocalcin (Oc). Urinary indices of bone resorption, deoxypyridinoline (DPD), pyridinoline (PyD), and hydroxyproline (OHP), were measured in a 2-h fasting urine. In 22 patients, computerized tomographic scan for bone mineral density (BMD) was performed. Results: The prevalence in groups 1, 2, and 3, respectively, of hypovitaminosis D (<50 nmol/L) was 58{\%}, 25{\%}, and 88{\%}, and the prevalence of SHPT (>5.4 pmol/L) was 25{\%}, 19{\%}, and 25{\%}. Bone resorption markers were significantly elevated in all groups, and bone formation indices were elevated in the newly diagnosed celiacs compared with a group of healthy adults. Low BMD (T-score greater than -1 SD unit) was found in 68{\%} of patients assessed; 36{\%} of patients had a T-score greater than -2.5 SD units. Conclusions: Hypovitaminosis D and SHPT are common in newly diagnosed and refractory celiacs but are less common in those who respond to a gluten-free diet. Newly diagnosed patients have a high bone turnover state with elevation of both bone formation and resorption indices. Those with refractory disease demonstrate a remodeling imbalance with high bone resorption.",
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AU - O'Donoghue, D. P.

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AB - Objectives: to determine the prevalence of hypovitaminosis D and secondary hyperparathyroidism (SHPT) and to assess bone turnover by using markers of bone formation and resorption in celiac disease (CD). Methods: Forty-three patients with CD were investigated: group 1, newly diagnosed celiacs (n = 19); group 2, treated celiacs responding histologically to a gluten-free diet (n = 16); group 3, refractory celiacs, unresponsive to a gluten-free diet and immunosuppressive therapy (n = 8). Serum was drawn for intact parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D], ionized calcium (Cai), total alkaline phosphatase (AP), and biochemical markers of bone formation: procollagen I carboxyterminal propeptide (PICP) and osteocalcin (Oc). Urinary indices of bone resorption, deoxypyridinoline (DPD), pyridinoline (PyD), and hydroxyproline (OHP), were measured in a 2-h fasting urine. In 22 patients, computerized tomographic scan for bone mineral density (BMD) was performed. Results: The prevalence in groups 1, 2, and 3, respectively, of hypovitaminosis D (<50 nmol/L) was 58%, 25%, and 88%, and the prevalence of SHPT (>5.4 pmol/L) was 25%, 19%, and 25%. Bone resorption markers were significantly elevated in all groups, and bone formation indices were elevated in the newly diagnosed celiacs compared with a group of healthy adults. Low BMD (T-score greater than -1 SD unit) was found in 68% of patients assessed; 36% of patients had a T-score greater than -2.5 SD units. Conclusions: Hypovitaminosis D and SHPT are common in newly diagnosed and refractory celiacs but are less common in those who respond to a gluten-free diet. Newly diagnosed patients have a high bone turnover state with elevation of both bone formation and resorption indices. Those with refractory disease demonstrate a remodeling imbalance with high bone resorption.

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