11.06.2005, 07:12
Arch Intern Med. 2005 Feb 28;165(4):393-9.
Comment in:
· Arch Intern Med. 2005 Feb 28;165(4):370-2.
Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis.
Stenson WF, Newberry R, Lorenz R, Baldus C, Civitelli R.
Divisions of Gastroenterology, Washington University School of Medicine, St Louis, MO 63110, USA. wstenson@im.wustl.edu
BACKGROUND: There is an increased prevalence of osteoporosis among patients with celiac disease. However, the relative prevalence of celiac disease among osteoporotic and nonosteoporotic populations is not known, and the benefit of screening the osteoporotic population for celiac disease remains controversial. METHODS: We evaluated 840 individuals, 266 with and 574 without osteoporosis, from the Washington University Bone Clinic by serologic screening for celiac disease. Individuals with positive serologic test results for antitissue transglutaminase or antiendomysial antibody were offered endoscopic intestinal biopsy to confirm the diagnosis of celiac disease. Individuals with biopsy-proven celiac disease were treated with a gluten-free diet and followed up for improvement in bone mineral density. RESULTS: Twelve (4.5%) of 266 patients with osteoporosis and 6 (1.0%) of 574 patients without osteoporosis tested positive by serologic screening for celiac disease. All but 2 serologically positive individuals underwent in-testinalbiopsy. Nine osteoporotic patients and 1 nonosteoporotic patient had positive biopsy results. The prevalence of biopsy-proven celiac disease was 3.4% among the osteoporotic population and 0.2% among the nonosteoporotic population. All biopsy-positive individuals tested positive by antitissue transglutaminase and antiendomysial antibody. The antitissue transglutaminase levels correlated with the severity of osteoporosis as measured by T score, demonstrating that the more severe the celiac disease the more severe the resulting osteoporosis. Treatment of the patients with celiac disease with a gluten-free diet resulted in marked improvement in T scores. CONCLUSIONS: The prevalence of celiac disease among osteoporotic individuals (3.4%) is much higher than that among nonosteoporotic individuals (0.2%). The prevalence of celiac disease in osteoporosis is high enough to justify a recommendation for serologic screening of all patients with osteoporosis for celiac disease.
http://www.ncbi.nlm.nih.gov/entrez/query...t=Abstract
***
Osteoporose tritt häufig als Folge unerkannter Laktoseintoleranz und Zöliakie auf. Amerikanische Gastroenterologen (das sind die Darmspezialisten unter den Ärzten) haben dies nun auch wissenschaftlich in Bezug auf Zöliakie untersucht.
Wegen der erstaunlich hohen Rate an parallel auftretender Osteoporose und Zöliakie, schlagen sie ein Screening aller OsteoporosepatientInnen auf Zöliakie vor.
Außerdem stellten sie fest, dass allein durch die Behandlung der Zöliakie mittels glutenfreier Ernährung, die Knochendichte ihrer PatientInnen wieder schnell angestiegen ist. Schneller sogar als unter der üblichen Osteoporose Standardbehandlung ( siehe http://www.milchlos.de , Neuigkeiten )
Wäre es da nicht an der Zeit, die bisherige „Logik“ : hohe Calcium-Zufuhr (vor allem aus Milchprodukten) = hohe Knochendichte zu überdenken? Sie gleicht eher der „Milchmädchenrechnung“ denn den Tatsachen!
Uli
Comment in:
· Arch Intern Med. 2005 Feb 28;165(4):370-2.
Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis.
Stenson WF, Newberry R, Lorenz R, Baldus C, Civitelli R.
Divisions of Gastroenterology, Washington University School of Medicine, St Louis, MO 63110, USA. wstenson@im.wustl.edu
BACKGROUND: There is an increased prevalence of osteoporosis among patients with celiac disease. However, the relative prevalence of celiac disease among osteoporotic and nonosteoporotic populations is not known, and the benefit of screening the osteoporotic population for celiac disease remains controversial. METHODS: We evaluated 840 individuals, 266 with and 574 without osteoporosis, from the Washington University Bone Clinic by serologic screening for celiac disease. Individuals with positive serologic test results for antitissue transglutaminase or antiendomysial antibody were offered endoscopic intestinal biopsy to confirm the diagnosis of celiac disease. Individuals with biopsy-proven celiac disease were treated with a gluten-free diet and followed up for improvement in bone mineral density. RESULTS: Twelve (4.5%) of 266 patients with osteoporosis and 6 (1.0%) of 574 patients without osteoporosis tested positive by serologic screening for celiac disease. All but 2 serologically positive individuals underwent in-testinalbiopsy. Nine osteoporotic patients and 1 nonosteoporotic patient had positive biopsy results. The prevalence of biopsy-proven celiac disease was 3.4% among the osteoporotic population and 0.2% among the nonosteoporotic population. All biopsy-positive individuals tested positive by antitissue transglutaminase and antiendomysial antibody. The antitissue transglutaminase levels correlated with the severity of osteoporosis as measured by T score, demonstrating that the more severe the celiac disease the more severe the resulting osteoporosis. Treatment of the patients with celiac disease with a gluten-free diet resulted in marked improvement in T scores. CONCLUSIONS: The prevalence of celiac disease among osteoporotic individuals (3.4%) is much higher than that among nonosteoporotic individuals (0.2%). The prevalence of celiac disease in osteoporosis is high enough to justify a recommendation for serologic screening of all patients with osteoporosis for celiac disease.
http://www.ncbi.nlm.nih.gov/entrez/query...t=Abstract
***
Osteoporose tritt häufig als Folge unerkannter Laktoseintoleranz und Zöliakie auf. Amerikanische Gastroenterologen (das sind die Darmspezialisten unter den Ärzten) haben dies nun auch wissenschaftlich in Bezug auf Zöliakie untersucht.
Wegen der erstaunlich hohen Rate an parallel auftretender Osteoporose und Zöliakie, schlagen sie ein Screening aller OsteoporosepatientInnen auf Zöliakie vor.
Außerdem stellten sie fest, dass allein durch die Behandlung der Zöliakie mittels glutenfreier Ernährung, die Knochendichte ihrer PatientInnen wieder schnell angestiegen ist. Schneller sogar als unter der üblichen Osteoporose Standardbehandlung ( siehe http://www.milchlos.de , Neuigkeiten )
Wäre es da nicht an der Zeit, die bisherige „Logik“ : hohe Calcium-Zufuhr (vor allem aus Milchprodukten) = hohe Knochendichte zu überdenken? Sie gleicht eher der „Milchmädchenrechnung“ denn den Tatsachen!
Uli