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Case-Finding for Adult Celiac Disease in Patients with Reduced Bone Mineral Density

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Abstract

The aim of this study was to assess the value of case-finding for unrecognized adult celiac disease (CD) in patients with reduced bone mineral density (BMD), verified by dual-energy X-ray absorptiometry (DXA). Patients attending for a DXA scan were investigated for CD using immunoglobulins, IgG/IgA antigliadin antibodies (AGA), and endomysial antibodies (EMA). All patients with a positive IgA AGA, EMA, or only IgG AGA in the presence of IgA deficiency had a small bowel biopsy. There were 12 cases of CD (12/978), a prevalence of 1.2% for the whole cohort. The prevalence of CD was 0.7% (2/304) for those with a normal BMD, 1.2% (5/431) for patients with osteopenia, and 2.1% (5/243) for patients with osteoporosis. Direct questioning revealed that all patients with unrecognized CD had subtle gastrointestinal symptoms or a history of anemia. Excluding patients without these symptoms would give a prevalence of 3.9% for osteoporosis (5/127) and 2.6% for osteopenia (5/191). This study suggests that there is no value of unselected case-finding for CD in patients with a reduced BMD. However, a targeted case-finding approach may be more valid and cost-effective with the initial selection of patients who should be investigated for CD based on questioning about gastrointestinal symptoms or anemia.

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Authors and Affiliations

  1. Gastroenterology and Liver Unit, Northern General Hospital, Sheffield, UK

    David S. Sanders MD, Fozia B. Khan MB, ChB, Rachel H. Westbrook MB, ChB & Chloe V. Webber MB, ChB

  2. Metabolic Bone Unit, Royal Hallamshire Hospital, Northern General Hospital, Sheffield, UK

    Eugene V. McCloskey MD

  3. Supra-Regional Protein Reference Unit, Northern General Hospital, Sheffield, UK

    Dina Patel PhD & Anthony Milford-Ward FRCpath

  4. 28 Botanical Road, Sheffield, S11 8RP, UK

    David S. Sanders MD

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  1. David S. Sanders MD
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  2. Dina Patel PhD
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  3. Fozia B. Khan MB, ChB
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Correspondence to David S. Sanders MD.

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Sanders, D.S., Patel, D., Khan, F.B. et al. Case-Finding for Adult Celiac Disease in Patients with Reduced Bone Mineral Density. Dig Dis Sci 50, 587–592 (2005). https://doi.org/10.1007/s10620-005-2479-y

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  • DOI: https://doi.org/10.1007/s10620-005-2479-y

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