{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T22:44:47Z","timestamp":1761518687470},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"903","license":[{"start":{"date-parts":[[2001,1,1]],"date-time":"2001-01-01T00:00:00Z","timestamp":978307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2001,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Bone mineral density was measured by dual energy x ray absorptiometry (DEXA) at the lumbar spine and femoral neck in 15 adults who had metabolic bone disease in association with coeliac disease (mean age at diagnosis 53.5 years, range 37 to 66). Results were expressed as a T score (the number of standard deviations by which patient\u2019s bone density differed from the sex matched young adult mean). Three patients had no skeletal symptoms and normal routine calcium biochemistry but severely reduced axial bone mineral density on DEXA. Eleven patients had symptomatic skeletal fractures, including fractures of proximal femur (3), vertebrae (4), and radius (6). Three patients had osteomalacia confirmed on bone biopsy, two of whom had characteristic biochemistry. Secondary and tertiary hyperparathyroidism were seen. Seventy five further patients (60 female) with coeliac disease (mean age 52.0 years, median duration of gluten-free diet 3.4 years) and 75 paired healthy age and sex matched controls were questioned on past fracture history. Patients with coeliac disease underwent detailed studies of calcium biochemistry, dietary intake, and bone mineral density. Sixteen had a past history of fractures (\u03c72\u2009=\u200910.7, p\u2009=\u20090.0004,v controls), which were of typical osteoporotic type. Ten patients had fracture before diagnosis of coeliac disease and six after diagnosis. Patients who had a fracture were older (56.3 v 50.3 years, p\u2009&amp;lt;\u20090.02, Wilcoxon rank sum test) than those with no fracture. There was no significant difference in bone mineral density (z score \u22120.31v \u22120.77), serum calcium (2.30v 2.26 mmol\/l), 25-hydroxyvitamin D (19.7v 23.7 nmol\/l), parathyroid hormone (2.6v 3.1 pmol\/l), or dietary calcium intake (1021.0 v 1033.0 mg\/day) in patients with fracture compared with those without fracture. Metabolic bone disease is common in coeliac disease and is associated with premature osteoporotic fractures.<\/jats:p>","DOI":"10.1136\/pmj.77.903.33","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T10:38:40Z","timestamp":1027766320000},"page":"33-36","source":"Crossref","is-referenced-by-count":64,"title":["The clinical impact of metabolic bone disease in coeliac disease"],"prefix":"10.1093","volume":"77","author":[{"given":"W E","family":"Fickling","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Royal United Hospital , Bath, Avon BA1 3NG, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"X A","family":"McFarlane","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Royal United Hospital , Bath, Avon BA1 3NG, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A K","family":"Bhalla","sequence":"additional","affiliation":[{"name":"Royal National Hospital for Rheumatic Diseases , Bath, Avon BA1 3NG, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D A F","family":"Robertson","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Royal United Hospital , Bath, Avon BA1 3NG, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2001,1,1]]},"reference":[{"key":"2023042418251251200_B1","first-page":"565","article-title":"Gluten induced enteropathy: osteomalacia as a principal manifestation.","volume":"131","author":"Hajjar","year":"1979","journal-title":"Arch Intern Med"},{"key":"2023042418251251200_B2","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1001\/archinte.1956.00250300092011","article-title":"Severe osteomalacia associated with occult steatorrhoea due to non tropical sprue. 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The study of osteoporotic fractures research group.","volume":"341","author":"Cummings","year":"1993","journal-title":"Lancet"},{"key":"2023042418251251200_B14","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/jbmr.5650100202","article-title":"How many women have osteoporosis now?","volume":"10","author":"Melton","year":"1995","journal-title":"J Bone Miner Res"},{"key":"2023042418251251200_B15","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0950-351X(88)80007-7","article-title":"Uses and limitations of bone biopsy in management of metabolic bone disease.","volume":"2","author":"Boyce","year":"1988","journal-title":"Ballieres Clin Endocrinol Metab"},{"key":"2023042418251251200_B16","first-page":"83","article-title":"Calcium metabolism and bone pathology in adult coeliac disease.","volume":"34","author":"Melvin","year":"1970","journal-title":"Q J Med"},{"key":"2023042418251251200_B17","first-page":"1078","article-title":"Coeliac sprue.","volume-title":"Gastrointestinal diseases. 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