Endocrine Abstracts

Objectives: Type one diabetes mellitus (T1DM) is associated with various autoimmune conditions including celiac disease. Both these conditions are independently and variably associated with risk of osteoporosis. The current study intended to study bone health parameters and factors affecting it in patients with T1DM with serological evidence of celiac disease (CD).

Methods: A cross sectional study including 100 type one diabetes patients following up in our hospital was screened for CD bye IgA tissue transglutaminase (TTG) levels. Twelve patients (12%) patients tested positive. Twenty age- and sex-matched T1DM (IgA TTG negative) patients served as controls. After history and physical examination, biochemical parameters including serum levels of ionized calcium, inorganic phosphorus, alkaline phosphatase, parathyroid hormone and 25 hydroxy vitamin D were measured. Bone mineral density (BMD) were measured at total body (TB), lumbar spine (LS) and left femoral neck (FN) using dual energy X-ray absorptiometry (Lunar DRX DPO). Similarly DXA scan was done for measurement of total body bone mineral content (TBBMC), bone area (TBBA) and body composition. All the parameters were expressed as mean±S.D. Data were analyzed using online graphpad quickcalc software and P<0.05 was considered statistically significant.

Results: TBBMD (0.77±0.04 vs 0.81±0.05 gm/cm²) and TBBMC (801±143 vs 982±196) were lower in type one diabetic subjects with IgA TTG positivity (P<0.05). Similarly the total body Z-score (−1.64±0.56 vs −0.46±0.67), lumbar spine Z-score (−1.42±0.61 vs −0.22±0.83) and femoral neck Z-score (−1.48±0.52 vs −0.34±0.79) and TBBMC for age Z-score (−1.3±0.8 vs −1.0±0.9) were lower in type one diabetic subjects with IgA TTG positivity (P< 0.05). However, TBBA (1038±149 vs 1134±156 cm²) and TBBA for age Z-score (−0.9±0.9 vs −0.8±0.9) did not significantly differ between the two groups.

Discussion: Celiac autoimmunity is associated with reduced bone mineralization in T1DM patients. Celiac disease should be considered as a possible secondary cause of osteopenia in type one diabetic patients found to have a reduced BMD.

Conclusion: Important impact of early identification of CD in T1DM could be to prevent this important complication.