Is It Necessary to Screen for Coeliac Disease in Osteoporotic Patients?

D C GONZALEZ; E SUGAI; J C GOMEZ; M.B. OLIVERI,; C GÓMEZ ACOTTO; E VEGA; A BAGUR; C MAUTALEN; J C BAI

TORONTO

Congreso; XXII CONGRESO ANUAL DE LA ASBMR; 2000

Decreased bone mass is a frequent finding in coeliac patients. On the other hand, Lindh et al. (J InternMed,1992;231:403-6) reported that subclinical coeliac disease (CD) appears to be unusually overrepresentedamong patients with idiopathic osteoporosis. This finding and the fact that silent coeliacdisease may be more common than previously believed, suggest that osteoporotic patients should bechecked for occult CD. In order to assess this hypothesis antigliadin antibodies (AGA), a useful tool fordetecting CD, were studied in 127 consecutive women, of 68 + 9 (mean + 1sd) years of age with verifiedosteoporosis . Nutritional deficiencies or suspicious gastrointestinal symptoms were absent or very mildin all the patients. AGA type IgA and IgG were performed by the micro Elisa method. The upper normallimits (mean + 2sd) were 15 arbitrary units (AU/ml) and 20 AU/ml for AGA IgA and IgG respectively.Antiendomysial antibody (EmA) was determined using indirect inmunofluorescence method, when highvalues of AGA IgA and/ or IgG were detected. Results were compared with those obtained in anepidemiological study about prevalence of adult CD in Buenos Aires, for which serum samples of 747healthy women (age: 27.8 years, range 16-78) were obtained in opportunity of the pre-nuptial exam.Five patients showed high titres of AGA IgA, and 3 high AGA IgG. EmA were negative in all of them.Only 1 patient (out of 127 screened) was found to have elevated values of both AGA IgA and IgG andpositive EmA. In this case CD was confirmed by jejunal biopsy. CD was diagnosed in 6 out of 747healthy women evaluated with the same screening tools. There was not significant difference in theprevalence of positive serology in osteoporotic patients (0.8%) versus controls (0.8%). The addition ofscreening for gliadin antibodies to the routine assessment of osteoporosis would not seem to be necessary,except in those patients with lack of response to usual therapies, or borderline laboratory findings