vitamin-d-2 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

Bone mineral density (125I photon absorptiometry) was lower in 20 untreated adult celiac patients than in sex- and age-matched controls (p less than 0.001), and plasma alkaline phosphatase, parathyroid hormone, urinary hydroxyproline/creatinine levels were higher than normal (p less than 0.05, less than 0.001, less than 0.05, respectively). Gluten-free diet was started, and the patients were divided randomly into two treatment groups, one which received oral 25-hydroxyvitamin D 50 micrograms/day and one which did not. After 12 months' treatment, bone turnover markers showed a decrease, which did not reach statistical significance, and bone mineral density did not show significant modifications compared with base line in either group. It was found that a gluten-free diet followed for 1 yr can prevent further bone loss, but no significant differences were detected between the two groups.

Topics: 25-Hydroxyvitamin D 2; Adolescent; Adult; Alkaline Phosphatase; Bone and Bones; Celiac Disease; Creatinine; Ergocalciferols; Female; Humans; Hydroxyproline; Iodine Radioisotopes; Male; Middle Aged; Minerals; Parathyroid Hormone; Radionuclide Imaging

Topics: Adult; Bone and Bones; Bone Diseases, Metabolic; Bone Neoplasms; Celiac Disease; Diagnosis, Differential; Diet, Gluten-Free; Ergocalciferols; Female; Humans; Neoplasms, Unknown Primary; Radiography; Radionuclide Imaging

Hypovitaminosis D and its consequences are significant complications in the course of untreated celiac disease (CD). We report a case that illustrates the natural evolution of osteomalacia in an adult patient with untreated CD and his response to vitamin D supplementation. In patients with complicated CD and hypovitaminosis D, vitamin D-2 replacement in high enough doses is important to improving functional performance and for the treatment of osteomalacia.

Topics: Calcium; Celiac Disease; Diet, Gluten-Free; Dose-Response Relationship, Drug; Ergocalciferols; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomalacia; Osteoporosis; Radiography; Spinal Diseases; Sternum; Thoracic Vertebrae; Vitamin D Deficiency