cholecalciferol and Celiac-Disease

The existing guidelines on screening and treatment are confusing because different guidelines target different populations. The IOM and AAP guidelines target generally healthy populations, whereas the Endocrine Society and other subspecialty guidelines target individuals with specific medical conditions associated with increased bone fragility. These distinctions have not always been well articulated. For healthy adolescents, the AAP does not recommend universal screening or screening of obese or dark-skinned individuals. Increased dietary intake of vitamin D is recommended, and vitamin D supplementation can be considered if the RDA cannot be met. For adolescents with chronic medical illnesses associated with increased fracture risk, screening for vitamin D deficiency should be performed by obtaining a serum 25-OHD level. Those found to be deficient (25-OHD level < 20 ng/mL) should be treated with doses of vitamin D2 or vitamin D3 higher than the daily requirement (as discussed in the section on vitamin D and chronic disease), followed by a maintenance dose. A repeat 25-OHD level should be obtained after the therapeutic course is completed. Some experts advocate for achievement of 25-OHD levels greater than 30 ng/mL in conditions associated with increased bone fragility, and several pediatric subspecialty organizations have made recommendations specific to the diseases they treat. In such instances, the recommendations of the pediatric subspecialty organizations should take precedence over the AAP recommendations for adolescents with chronic illnesses associated with increased bone fragility because the AAP recommendations were primarily targeted at a healthy population.

Topics: Adolescent; Celiac Disease; Cholecalciferol; Comorbidity; Cystic Fibrosis; Ergocalciferols; Feeding and Eating Disorders; Humans; Inflammatory Bowel Diseases; Mass Screening; Practice Guidelines as Topic; Rheumatic Diseases; Vitamin D; Vitamin D Deficiency; Vitamins

The symptoms of celiac disease (CD) are varied and metabolic bone disease (MBD) is less recognized amongst all manifestations in CD patients. Bone disease in CD is attributed to secondary hyperparathyroidism, which in turn is associated with increased bone remodelling. Improvement in bone mineral density (BMD) with gluten free diet (GFD) is known, but the data on efficacy of bisphosphonates in CD patients are limited. Bisphosphonates being a potent inhibitor of bone resorption may be useful in patients with CD having low BMD. The aim of the present investigation was to study the effect of zoledronic acid on BMD in CD patients.. A total of 28 CD patients were randomized to receive GFD, calcium and cholecalciferol (group A), and zoledronic acid (group B). Baseline biochemical tests and T-score by dual energy x-ray absorptiometer were done and repeated after 12 months.. The T-score showed improvement in the control arm (group A) from -3.31 ± 1.46 to -2.12 ± 1.44, a gain of 35.9 per cent (P<0.05) and in drug arm (group B) -2.82 ± 1.27 to -1.06 ± 1.84, registering a gain of 62.4 per cent (P<0.001). However, there was no difference in improvement of T-score in zoledronic acid group as compared to the control group.. Administration of zoledronic acid was not found to be better than GFD alone in increasing BMD in CD patients with low BMD in this pilot study.

Topics: Absorptiometry, Photon; Adult; Bone Density; Calcium; Celiac Disease; Cholecalciferol; Diet, Gluten-Free; Diphosphonates; Female; Humans; Imidazoles; Male; Pilot Projects; Zoledronic Acid

Previous studies have shown a relationship between vitamin D and celiac disease (CD), however little evidence is available examining the direct effects of vitamin D on pathological features of this disease. In this study we evaluated the effect of oral administration of different doses of native vitamin D3 (cholecalciferol) in enteropathic mice. Female non-obese diabetic (NOD)/ShiLt.J mice were fed standard or gluten-free diet and administered gliadin (5 μg/kg) to induce a celiac pathology. Healthy control (gluten-free diet, without gliadin) and control for pathology (standard diet, with gliadin) were administered olive oil. All other experimental groups received gliadin and standard diet plus oral cholecalciferol (5, 10, 20, 50 and 130 μg/kg). Serum levels of 25(OH)D3, calcium and zonulin and expression of vitamin D receptor (VDR), CD3 and zonula occludens-1 (ZO-1) by immunohistochemistry as well as intestinal histological and histomorphometric analyses were undertaken. Although no difference in serum levels of 25(OH)D3, calcium or zonulin was observed in cholecalciferol-treated mice vs. healthy controls, a significant improvement in intestinal mucosa pathological features in mice administered cholecalciferol was observed by histological analysis. Villi length was also significantly increased by cholecalciferol in a dose-dependent manner. Immunohistochemical staining revealed increased expression of CD3 and ZO-1 in celiac mice compared to mice receiving high dose (130 μg/kg) cholecalciferol. These findings show the effect of oral cholecalciferol on signature features of CD in a mouse model of CD. Further dose-ranging studies to investigate the efficacy of cholecalciferol for the treatment of CD are warranted.

Topics: Animals; Calcifediol; Calcium; Calcium, Dietary; Celiac Disease; Cholecalciferol; Disease Models, Animal; Female; Gliadin; Mice; Mice, Inbred NOD; Vitamin D

Secondary osteoporosis occurs in many diseases. Celiac disease-induced osteoporosis is the consequence of secondary hyperparathyroidism. Biochemical bone markers show predominance of bone resorption, thus making the bisphosphonates the first line therapy option. Intestinal mucosal changes are reversible on gluten-free diet. Osteoporosis reversibility is also possible, provided postmenopausal osteoporosis risk factors independent from celiac disease are not present.. We presented a postmenopausal woman with at least a 10-year history of celiac disease prior to diagnosis, which had overt secondary hyperparathyroidism with insufficient status of vitamin D and a significant bone mass reduction. At the time of diagnosis of celiac disease the patient was receiving 250 μg of levothyroxine daily without achieving optimal substitution. Three years after the initiation of gluten-free diet the patient was without any signs and symptoms of the disease. All laboratory findings were within normal range. It was decided to treat the underlying disease and to supplement calcium and vitamin D without the initiation of bisphosponate therapy.. Osteoporosis regression justified this therapeutic approach. The presence of primary autoimmune hypothyroidism makes this case specific, since the inability for optimal substitution therapy with a high daily dose of levothyroxine provoked the suspicion of celiac disease.

Topics: Calcium; Celiac Disease; Cholecalciferol; Diet, Gluten-Free; Female; Humans; Hyperparathyroidism, Secondary; Middle Aged; Osteoporosis, Postmenopausal; Thyroxine; Vitamin D; Vitamin D Deficiency

To investigate the prevalence of both calcium metabolism alterations and bone defects in children with celiac disease (CD).. We studied 54 untreated patients with CD (mean age, 7 years). We compared the serum concentration of calcium, magnesium, 25(OH)vitamin D3, alkaline phosphatase, and parathyroid hormone (PTH) of patients with CD with those of 60 healthy children. Children with CD with 2 laboratory alterations underwent DEXA examination, which was evaluated after 6 months of a gluten-free diet (GFD).. The calcium and the 25(OH)vitamin D3 levels were lower in children with CD than in control subjects, and the PTH level was higher in children with CD than in control subjects (P < .001). Hyperparathyroidism was found in 29 children with CD. Twenty patients tested positive for 2 laboratory alterations, and 10 of them were osteopenic. After 6 months of GFD calcium, 25(OH)vit.D3 and PTH levels normalized, with the improvement of bone mineral density.. Calcium metabolism defects are common in untreated children with CD, and they returned to normal after GFD. A detailed, time-consuming, and expensive study of bone metabolism is not necessary in children with CD shortly exposed to gluten who follow the GFD.

Topics: Absorptiometry, Photon; Alkaline Phosphatase; Biomarkers; Bone Diseases, Metabolic; Calcium; Celiac Disease; Child; Cholecalciferol; Comorbidity; Costs and Cost Analysis; Female; Glutens; Humans; Magnesium; Male; Parathyroid Hormone; Prevalence

Topics: Adult; Celiac Disease; Cholecalciferol; Female; Humans; Hyperparathyroidism, Secondary; Osteomalacia; Pregnancy; Pregnancy Complications

Topics: Adult; Arthralgia; Bone Density Conservation Agents; Calcium; Celiac Disease; Cholecalciferol; Diagnosis, Differential; Drug Therapy, Combination; Female; Fractures, Bone; Humans; Hyperparathyroidism, Secondary; Neoplasms; Obesity; Treatment Outcome; Weight Loss

Vitamin D-deficient osteomalacia with pronounced secondary hyperparathyroidism was observed in an acromegalic patient suffering from adult celiac disease. Two oral tests with tritiated vitamin D3 showed a nearly normal absorption coefficient, contrasting with a marked steatorrhea mainly due to functional and reversible pancreatic insufficiency. The urinary excretion of the radioactive label was strikingly increased and accounted for the completely flat curve of plasma radioactivity. This urinary loss of mainly water-soluble metabolite(s) of vitamin D3 represents a unique and presently unexplained feature.

Topics: Acromegaly; Celiac Disease; Cholecalciferol; Female; Humans; Hyperparathyroidism, Secondary; Middle Aged; Osteomalacia

Topics: Adult; Alcoholic Intoxication; Anti-Bacterial Agents; Bile Acids and Salts; Blind Loop Syndrome; Celiac Disease; Cholecalciferol; Chronic Disease; Feces; Humans; Intestinal Absorption; Intestinal Diseases; Intubation, Gastrointestinal; Jejunum; Malabsorption Syndromes; Male; Osteomalacia; Pancreatic Extracts; Pancreatitis; Tritium; Vitamin D Deficiency

Topics: Adolescent; Adult; Aged; Celiac Disease; Cholecalciferol; Female; Gastrectomy; Humans; Intestinal Absorption; Lipid Metabolism; Liver Cirrhosis; Malabsorption Syndromes; Male; Middle Aged; Osteomalacia; Pancreatitis; Protein-Losing Enteropathies; Rickets; Tritium; Vitamin D Deficiency

Topics: Adult; Aged; Celiac Disease; Cholecalciferol; Cholestasis; Chromatography, Thin Layer; Feces; Humans; Intestinal Absorption; Malabsorption Syndromes; Middle Aged; Urine