Celiac disease (CD) is a gluten sensitive enteropathy with intestinal and extra intestinal presentations in genetically predisposed cases. Musculoskeletal problems are one of the most common extra intestinal manifestations in adult Celiac disease. Most researches by now in bone loss in CD have limitation by not excluding age as most important confounding factor .In present study we evaluated bone mineral density(BMD) in men less than 55 years old and premenopausal women and men with CD.

This was a retrospective cross-sectional study of adult CD patients who were referred to the Mashhad Celiac Disease Center between 2008 and 2019. We excluded the bone loss confounding factors including cases with endocrine disorders, corticosteroid consumption, smoking, and women over the age of 50 or menopause. Factors such as intestinal pathology, bone mineral density (BMD), serum level of anti-tTG, serum vitamin D, and hemoglobin levels were also assessed at the time of diagnosis.

: BMD was observed in 421 out of 1000 patients. Femoral osteopenia was found in 155(36.8%) patients, and osteoporosis was also observed in 46 (10.9%) of patients. Spinal osteopenia and osteoporosis were observed in 140 (33%) and 54 (12.9%) of patients, respectively. The D3 level was normal in 32.2%, low in 35.9%, and insufficient in 31.9% of cases and no association with TTG level (P= 0.0001). Male patients have more risk of osteoporosis than female ,but female patients are at more risk for osteopenia in femoral. Generally, there was not any correlation between TTG levels, ,calcum ,phosphor and 25OH D3in normal and low BMD patients, including those with osteopenia and osteoporosis.

Even after excluding most important confounding factor in bone loss , osteopenia and osteoporosis was common in celiac patients and we should screen and treat them .