Long‐term effect of gluten restriction on bone mineral density of patients with coeliac disease

Aim: To assess the long-term effect of a gluten-free diet on bone mineral density of adults with untreated coeliac disease. Methods: Bone mineral density was assessed at baseline and after a mean duration of 37 months of treatment in 25 unselected newly diagnosed coeliac patients. Results: At baseline, osteopenia (>−1 s.d. below normal) was evident in the lumbar spine and total skeleton in 18 (72%) and 21 (84%) patients, respectively. At the end of the study, bone density had increased (mean bone mass Z-score increase: Z-score +1.0 for the lumbar spine and +1.1 for total skeleton) in 22 and 23 patients, respectively. Patients who adhered to strict gluten restriction (n=15) demonstrated a similar bone remineralization in the spine than those patients with partial compliance (n=10) (mean Z-score increase: +1.0, in both areas). A greater mean annual change in Z-score in the total skeleton was noted in patients who followed strict gluten restriction (0.4±0.1) respect to those with partial compliance (0.3±0.1); however, this difference was not statistically significant. Pre-menopausal women had significantly greater remineralization that post-menopausals (P>0.05). Remineralization showed an inverse correlation with the degree of basal osteopenia (r=−0.525; P<0.002). Conclusions: Long-term treatment with gluten-free diet produces a significant improvement in bone density in coeliac patients. Remineralization was more pronounced in patients who better comply with gluten-free diet, in pre-menopausal women and in patients with the lowest baseline bone mineral density.