{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T04:45:01Z","timestamp":1786164301594,"version":"build-2736575974"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 degli Studi di Roma La Sapienza"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Intern Emerg Med"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Patients with celiac disease have lower bone mineral density (BMD) and higher incidence of fractures compared to age- and sex-matched controls. There are no studies of denosumab, an antiresorptive drug, which is a fully human monoclonal antibody that binds the receptor activator of NF\u03baB ligand (RANKL) in celiac patients with osteoporosis. The aim is to study the long-term effect of denosumab on BMD in celiac patients with osteoporosis on a gluten-free diet (GFD), compared to non-celiac osteoporotic patients. Fifteen celiac patients with osteoporosis and control subjects of the same age, sex, BMI, and fragility fractures were enrolled. At baseline, each patient underwent biochemical tests, spine X-ray, and DXA measurements, and the Charlson Comorbidity Index (CCI) was computed. At each visit (every 2\u00a0years\u2009\u00b1\u20096\u00a0months), with a follow-up of 4\u00a0years, any adverse events or new clinical fractures, DXA measurements, and CCI were recorded. In celiac patients, a statistically significant median delta increase in total hip\n                    <jats:italic>T<\/jats:italic>\n                    -score of 0.11 compared to baseline was observed (ANOVA\n                    <jats:italic>p<\/jats:italic>\n                    &lt;\u20090.05), while in the control group, it was 0.07 (ANOVA\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05), with no difference between groups. New fractures occurred in the celiac group in five patients during the follow-up, and in two patients in the control group (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.38). No adverse events occurred during follow-up. In celiac patients with osteoporosis on GFD, denosumab, with up to 4\u00a0years of follow-up, increased hip BMD without adverse events.\n                  <\/jats:p>","DOI":"10.1007\/s11739-026-04360-8","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:21:42Z","timestamp":1777396902000},"page":"1733-1738","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term treatment with denosumab in patients with celiac disease and osteoporosis at high risk of fracture: a retrospective study"],"prefix":"10.1007","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3088-0673","authenticated-orcid":false,"given":"Jessica","family":"Pepe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Colangelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachele","family":"Santori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Occhiuto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Diacinti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evaristo","family":"Ettorre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovambattista","family":"Desideri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Minisola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Cipriani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"4360_CR1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15051089","volume":"15","author":"L Lungaro","year":"2023","unstructured":"Lungaro L, Manza F, Costanzini A et al (2023) Osteoporosis and celiac disease: updates and hidden pitfalls. Nutrients 15:1089. https:\/\/doi.org\/10.3390\/nu15051089","journal-title":"Nutrients"},{"key":"4360_CR2","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.dld.2007.09.006","volume":"40","author":"M Olmos","year":"2008","unstructured":"Olmos M, Antelo M, Vazquez H et al (2008) Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease. Dig Liver Dis 40:46\u201353. https:\/\/doi.org\/10.1016\/j.dld.2007.09.006","journal-title":"Dig Liver Dis"},{"key":"4360_CR3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1210\/jc.2014-1858","volume":"100","author":"K Heikkila","year":"2015","unstructured":"Heikkila K, Pearce J, Maki M, Kaukinen K (2015) Celiac disease and bone fractures: a systematic review and meta-analysis. J Clin Endocrinol Metab 100:25\u201334. https:\/\/doi.org\/10.1210\/jc.2014-1858","journal-title":"J Clin Endocrinol Metab"},{"key":"4360_CR4","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2023.116913","volume":"177","author":"S Hansen","year":"2023","unstructured":"Hansen S, Schwarz P, Rumessen J et al (2023) Osteoporosis and bone fractures in patients with celiac disease: a nationwide cohort study. Bone 177:116913. https:\/\/doi.org\/10.1016\/j.bone.2023.116913","journal-title":"Bone"},{"key":"4360_CR5","doi-asserted-by":"publisher","first-page":"2347","DOI":"10.1210\/jc.2015-1392","volume":"100","author":"EM Stein","year":"2015","unstructured":"Stein EM, Rogers H, Leib A et al (2015) Abnormal skeletal strength and microarchitecture in women with celiac disease. J Clin Endocrinol Metab 100:2347\u20132353. https:\/\/doi.org\/10.1210\/jc.2015-1392","journal-title":"J Clin Endocrinol Metab"},{"key":"4360_CR6","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.bone.2015.03.005","volume":"76","author":"MB Zanchetta","year":"2015","unstructured":"Zanchetta MB, Costa F, Longobardi V et al (2015) Significant bone microarchitecture impairment in premenopausal women with active celiac disease. Bone 76:149\u2013157. https:\/\/doi.org\/10.1016\/j.bone.2015.03.005","journal-title":"Bone"},{"key":"4360_CR7","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1007\/s00223-023-01155-3","volume":"114","author":"K Skoracka","year":"2024","unstructured":"Skoracka K, Hryhorowicz S, Tovoli F et al (2024) Genetic, immunological, dietary, gut microbiota, and environmental determinants of osteoporosis in the course of celiac disease: which factor plays the first violin in this orchestra? Calcif Tissue Int 114:98\u2013109. https:\/\/doi.org\/10.1007\/s00223-023-01155-3","journal-title":"Calcif Tissue Int"},{"key":"4360_CR8","doi-asserted-by":"publisher","first-page":"4554","DOI":"10.3390\/nu14214554","volume":"14","author":"A Al-Toma","year":"2022","unstructured":"Al-Toma A, Herman A, Lems WF, Mulder CJJ (2022) The dietary and non-dietary management of osteoporosis in adult-onset celiac disease: current status and practical guidance. Nutrients 14:4554. https:\/\/doi.org\/10.3390\/nu14214554","journal-title":"Nutrients"},{"key":"4360_CR9","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1016\/j.cgh.2017.09.054","volume":"16","author":"MB Zanchetta","year":"2018","unstructured":"Zanchetta MB, Costa AF, Longobardi V et al (2018) Improved bone microarchitecture in patients with celiac disease after 3 years on a gluten-free diet. Clin Gastroenterol Hepatol 16:774\u2013775. https:\/\/doi.org\/10.1016\/j.cgh.2017.09.054","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"2","key":"4360_CR10","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1111\/jgh.13060","volume":"31","author":"ED Newnham","year":"2016","unstructured":"Newnham ED, Shepherd SJ, Strauss BJ, Hosking P, Gibson PR (2016) Adherence to the gluten-free diet can achieve the therapeutic goals in almost all patients with coeliac disease: a 5-year longitudinal study from diagnosis. J Gastroenterol Hepatol 31(2):342\u2013349. https:\/\/doi.org\/10.1111\/jgh.13060","journal-title":"J Gastroenterol Hepatol"},{"key":"4360_CR11","first-page":"882","volume":"138","author":"M Kumar","year":"2013","unstructured":"Kumar M, Rastogi A, Bhadada SK et al (2013) Effect of zoledronic acid on bone mineral density in patients of celiac disease: a prospective, randomized, pilot study. Indian J Med Res 138:882\u2013887","journal-title":"Indian J Med Res"},{"key":"4360_CR12","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1093\/jbmr\/zjae079","volume":"39","author":"JR Curtis","year":"2024","unstructured":"Curtis JR, Arora T, Liu Y et al (2024) Comparative effectiveness of denosumab vs alendronate among postmenopausal women with osteoporosis. J Bone Miner Res 39:826\u2013834. https:\/\/doi.org\/10.1093\/jbmr\/zjae079","journal-title":"J Bone Miner Res"},{"key":"4360_CR13","doi-asserted-by":"publisher","first-page":"154","DOI":"10.3748\/wjg.v28.i1.154","volume":"28","author":"A Raiteri","year":"2022","unstructured":"Raiteri A, Granito A, Giamperoli A et al (2022) Current guidelines for the management of celiac disease: a systematic review with comparative analysis. World J Gastroenterol 28:154\u2013175. https:\/\/doi.org\/10.3748\/wjg.v28.i1.154","journal-title":"World J Gastroenterol"},{"issue":"11","key":"4360_CR14","doi-asserted-by":"publisher","first-page":"2391","DOI":"10.1007\/s40618-023-02095-3","volume":"46","author":"J Pepe","year":"2023","unstructured":"Pepe J, Colangelo L, De Martino V et al (2023) Study of the link between hemotopoietic and skeletal systems in patients attending a referral center for osteoporosis. J Endocrinol Invest 46(11):2391\u20132397. https:\/\/doi.org\/10.1007\/s40618-023-02095-3","journal-title":"J Endocrinol Invest"},{"key":"4360_CR15","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650080915","author":"HK Genant","year":"1993","unstructured":"Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. https:\/\/doi.org\/10.1002\/jbmr.5650080915","journal-title":"J Bone Miner Res"},{"issue":"5","key":"4360_CR16","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-968(87)90171-8","volume":"40","author":"ME Charlson","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373\u2013383. https:\/\/doi.org\/10.1016\/0021-968(87)90171-8","journal-title":"J Chronic Dis"},{"key":"4360_CR17","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1007\/s00198-021-06274-x","volume":"33","author":"S Minisola","year":"2022","unstructured":"Minisola S, Cipriani C, Vigna E et al (2022) COVID pandemic and denosumab adherence. Osteoporos Int 33:943\u2013944. https:\/\/doi.org\/10.1007\/s00198-021-06274-x","journal-title":"Osteoporos Int"},{"key":"4360_CR18","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1007\/s40618-018-0898-9","volume":"41","author":"C Cipriani","year":"2018","unstructured":"Cipriani C, Pepe J, Minisola S, Lewiecki EM (2018) Adverse effects of media reports on the treatment of osteoporosis. J Endocrinol Invest 41:1359\u20131364. https:\/\/doi.org\/10.1007\/s40618-018-0898-9","journal-title":"J Endocrinol Invest"},{"key":"4360_CR19","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1210\/clinem\/dgab888","volume":"107","author":"AD Anastasilakis","year":"2022","unstructured":"Anastasilakis AD, Pepe J, Napoli N et al (2022) Osteonecrosis of the jaw and antiresorptive agents in benign and malignant diseases: a critical review organized by the ECTS. J Clin Endocrinol Metab 107:1441\u20131460. https:\/\/doi.org\/10.1210\/clinem\/dgab888","journal-title":"J Clin Endocrinol Metab"},{"key":"4360_CR20","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1080\/17446651.2019.1575727","volume":"14","author":"L Colangelo","year":"2019","unstructured":"Colangelo L, Biamonte F, Pepe J et al (2019) Understanding and managing secondary osteoporosis. Expert Rev Endocrinol Metab 14:111\u2013122. https:\/\/doi.org\/10.1080\/17446651.2019.1575727","journal-title":"Expert Rev Endocrinol Metab"},{"key":"4360_CR21","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1055\/s-2006-944548","volume":"38","author":"CE Fiore","year":"2006","unstructured":"Fiore CE, Pennisi P, Ferro G et al (2006) Altered osteoprotegerin\/RANKL ratio and low bone mineral density in celiac patients on long-term treatment with gluten-free diet. Horm Metab Res 38:417\u2013422. https:\/\/doi.org\/10.1055\/s-2006-944548","journal-title":"Horm Metab Res"}],"container-title":["Internal and Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-026-04360-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11739-026-04360-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-026-04360-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T04:38:51Z","timestamp":1786163931000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11739-026-04360-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":21,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["4360"],"URL":"https:\/\/doi.org\/10.1007\/s11739-026-04360-8","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-6460258\/v1","asserted-by":"object"}]},"ISSN":["1828-0447","1970-9366"],"issn-type":[{"value":"1828-0447","type":"print"},{"value":"1970-9366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]},"assertion":[{"value":"18 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"S.M. served as a speaker for Abiogen, Beijing Society Biomedical Engineering, GeoPharma, Sandoz, and UCB. He also served on the advisory board of Kyowa Kirin and Faes Farma. C.C. served as a speaker for Abiogen and on the advisory board of IBSA. The other authors have no conflicts to declare.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by our local ethics committee (protocol number 7649)","order":2,"name":"Ethics","label":"Human and animal rights statement","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from each patient included in the study.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}