http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15310538
Celiac disease manifesting as isolated hypocalcemia.
Rickels MR, Mandel SJ.
Division of Endocrinology, Diabetes and Metabolism, Department of
Medicine, University of Pennsylvania School of Medicine, Philadelphia,
Pennsylvania 19104, USA.
OBJECTIVE: To describe a patient who presented with hypocalcemia and
hypocalciuria as the initial manifestations of celiac disease, despite
a normal vitamin D status. METHODS: We review the diagnostic
evaluation, treatment, and biochemical and bone mineral density
responses of a patient with asymptomatic celiac disease, which was
initially suggested because of a low serum calcium level that became
attributable to isolated malabsorption of calcium. RESULTS: A
36-year-old woman presented with hypocalcemia in the presence of normal
serum 25-hydroxyvitamin D and high serum 1,25-dihydroxyvitamin D
levels. She had hypocalciuria and secondary hyperparathyroidism that
were refractory to pharmacologic calcium and cholecalciferol
supplementation. Fecal calcium excretion indicated malabsorption of
calcium, and biopsy of the small intestine demonstrated pathologic
changes characteristic of celiac disease. Bone mineral density,
determined by dual-energy x-ray absorptiometry, was in the osteopenic
range at the femoral neck. The initiation of a gluten-free diet
resulted in correction of all biochemical abnormalities and a
substantial increase in bone mineral density. CONCLUSION: Primary
intestinal malabsorption of calcium without concomitant vitamin D
deficiency is possible in celiac disease because of the preferential
involvement of the proximal small intestine early in the disease
process. Our patient had hypocalcemia caused by celiac disease and
values for serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D that
were normal and elevated, respectively. Correction was demonstrated
after dietary gluten withdrawal.
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15176994
Imbalance of osteoclastogenesis-regulating factors in patients with
celiac disease.
Taranta A, Fortunati D, Longo M, Rucci N, Iacomino E, Aliberti F,
Facciuto E, Migliaccio S, Bardella MT, Dubini A, Borghi MO, Saraifoger
S, Teti A, Bianchi ML.
Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a
Carattere Scientifico, Roma, Italy.
Celiac disease is an autoimmune disorder characterized by atrophy of
the intestine villi triggered by ingestion of gluten in genetically
susceptible individuals. The association between celiac disease and low
BMD has been recognized, but the mechanisms of disturbance are poorly
understood. We show imbalance of cytokines relevant to bone metabolism
in celiac patients' sera and the direct effect of these sera on in
vitro bone cell activity. INTRODUCTION: Celiac disease is associated
with mineral metabolism derangement and low BMD. We investigated
whether imbalance of serum factors in celiac patients could affect
human bone cell activity in vitro. MATERIALS AND METHODS: We studied
two groups of celiac patients--one on a gluten-free diet and another
before the diet--both with decreased bone mass. Patients were
investigated for bone turnover markers, and their sera were used for
culturing bone cells from healthy donors and evaluate changes in cell
activity. RESULTS: The N-terminal telopeptide of procollagen type I and
interleukin (IL)-6 were higher than normal in patients not on the
gluten-free diet. IL-1beta and TNF-alpha/beta were normal in all
patients. IL-12 was reduced in all patients, whereas IL-18 was reduced
only in patients on the diet. The RANKL/osteoprotegerin (OPG) ratio was
increased in patients not on the gluten-free diet. Persistently
increased osteoclast numbers were obtained from peripheral blood
mononuclear cells of healthy donors on incubation with sera of patients
not on the gluten-free diet versus control sera and sera from patients
on the diet. In human osteoblasts from healthy individuals, IL-18 was
reduced on incubation with sera from all patients, whereas OPG
expression was lower when sera from patients not on the diet were used.
Proliferation, alkaline phosphatase, and nodule mineralization were
increased in osteoblast cultures containing sera from all celiac
patients, either on or not on the gluten-free diet.Conclusions: We
conclude that bone loss in celiac disease might also be caused by a
cytokine imbalance directly affecting osteoclastogenesis and osteoblast
activity.
PMID: 15176994 [PubMed - indexed for MEDLINE]
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15052725
[Compliance with gluten free diet, physical development and bone
mineral status in patients with celiac disease]
[Article in Polish]
Grzenda-Adamek Z, Piatkowska E, Strzepek J, Przybyszewska K, Kruszewska
M.
Klinika Pediatrii Gastroenterologii i Zywienia, Polsko-Amerykanski
Instytut Pediatrii Collegium Medicum Uniwersytetu Jagiellonskiego w
Krakowie.
OBJECTIVES: The aim of the study was the assessment of the influence of
a gluten free diet on physical development and bone mineral density
(BMD) in patients with celiac disease. MATERIALS & METHODS: 59 patients
(40 girls, 19 boys) aged 10-20 years with celiac disease, diagnosed
according to ESPGAN criteria were included in the study. Patients were
divided in 3 groups: 1--strict gluten free diet, II--not entirely
compliant i.e. faults in gluten free diet 1-2 times per week,
III--gluten free diet not followed or frequent faults. Daily calcium
(Ca) intake and physical activity was assessed. BMD of the lumbar spine
L2-L4 was measured by dual-energy-X-ray absorptiometry with LUNAR
DPX-IQ. Physical development was assessed by anthropometric
measurements: growth and weight. RESULTS: Gluten free diet was strictly
followed by 16 (27%) patients (group I), group II consisted of 23 (39%)
patients. Diet was not followed by 20 (34%) patients. Thirty five (59%)
patients had low Ca intake and they made up the majority of the
patients in every group. High physical activity declared 35 (59%)
patients. No statistically significant differences in BMD were found
between group I and II. BMD was lower in group III in comparison to
group I (p = 0.01) and group II (p = 0.003). BMD was higher in patients
with high Ca intake (p = 0.002). Physical activity had no significant
influence on BMD. There was no statistically significant difference in
physical development between groups. CONCLUSIONS: Majority of the
patients with celiac disease did not strictly follow gluten free diet.
Poor compliance to the diet had no significant influence on physical
development. BMD was lower in patients who were not compliant to the
gluten free diet, occasional faults in the diet had no influence on the
BMD.
PMID: 15052725 [PubMed - indexed for MEDLINE]
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14684411
Longitudinal changes in bone metabolism and bone mineral content in
children with celiac disease during consumption of a gluten-free diet.
Barera G, Beccio S, Proverbio MC, Mora S.
Department of Pediatrics, Scientific Institute H San Raffaele, Milan,
Italy.
BACKGROUND: A gluten-free diet (GFD) rapidly corrects the bone mineral
deficit of children with untreated celiac disease. The mechanisms
underlying such changes are still poorly understood. OBJECTIVE: In a
longitudinal study, we monitored changes in bone metabolism during
consumption of a GFD. DESIGN: We studied 22 white patients with celiac
disease (11 girls) aged 10.5 +/- 1.0 y at the time of diagnosis. We
compared bone metabolism and bone mass values in these patients with
those in 428 healthy white children aged 11.3 +/- 0.2 y. Bone-specific
alkaline phosphatase (a bone formation index) and N-terminal
telopeptide of type I collagen (NTx; a bone resorption marker) were
measured at the time of diagnosis and after 2, 6, and 12 mo of the GFD.
Bone mineral content was measured at the lumbar spine and for the whole
skeleton. RESULTS: The bone mineral content of patients was
significantly lower than that of control subjects at the time of
diagnosis but not after 1 y of the GFD. Serum bone-specific alkaline
phosphatase concentrations of patients were significantly lower than
those of control subjects at the time of diagnosis (P = 0.0064) and
increased gradually and significantly during the GFD (ANOVA F = 4.71; P
= 0.024). Conversely, patients with untreated disease had significantly
higher urinary concentrations of NTx than did healthy control subjects
(P < 0.0001). Urinary concentrations of NTx were not significantly
affected by treatment (P = 0.37). CONCLUSIONS: The rate of bone
metabolism is altered in children with untreated celiac disease, and
these alterations may be the cause of osteopathy. Remarkable changes
occur after the initiation of a GFD, and they result in a more balanced
equilibrium.
Publication Types:
Clinical Trial
PMID: 14684411 [PubMed - indexed for MEDLINE]
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It is not the presence or or absence of milk that is the problem, it is
the presence of gluten-containing foods in the diet. A diet high in
gluten containing grains causes low BMD, coeliac disease and many other
problems.
TC
Tim Campbell said:Consumption of milk does in no way ensure strong and healthy bones,
for
Quoted message said:
both us as well as children. The Physicians Committee for Responsible
Medicine, USA, has made this startling revelation for all those of us
who may have been relying on milk for all our calcium needs.
Out of 37 studies conducted, only about 10 were found to be
supporting
Quoted message said:milk intake for children aged above 7 years. In fact, some believe
that
Quoted message said:once a child is on solid foods i.e. after a child has weaned, milk is
a
Quoted message said:strict no-no. Interestingly, man is the only exception to all other
animals on earth to consume milk after weaning.
Also, the total fat intake from dairy products in the diets of
American
Quoted message said:children who are increasingly turning obese is a good 25 percent
whereas the total energy provided by these products was found to be
only 18 percent. Alternatively, low fat dairy products can be used to
avail valuable nutrients like vitamin D other than calcium, which is
just as for strong bones.
Supporting a vegan diet, the PCRM offers other alternatives to milk
that are rich in calcium as well. For instance, a cup of orange juice
is recommended as it contains an equal quantity of calcium as in a
glass of milk. Oats, Kale, Turnip greens, tofu and broccoli are also
part of the rich calcium family.
Hence, healthy ways for children to achieve tougher bones is a lot of
exercise, which means more of outdoor games, and of course,
consumption
Quoted message said:of up to 1,300 milligrams of calcium a day.
