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Osteoporosis and Celiac Disease

Osteoporosis Is Sometimes The Only Sign Of Celiac Disease

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Updated May 12, 2009

Osteoporosis and Celiac Disease

Microtomographic rendition of bone architecture from bone in the spine of a young, normal person.

Prof. Ralph Müller, PhD, Institute for Biomechanics, ETH Zurich, Switzerland
Osteoporosis and celiac disease commonly appear together. It's very important to understand why, and to know what symptoms to look for.

What Is Osteoporosis?

Osteoporosis is a disease in which the bones are less dense than normal. The decreased density makes the bones more fragile and more likely to break. "Osteo" is Latin for bone, and "porosis" is derived from a word meaning spongy, or porous. In a related condition, called osteopenia, bone density is lower than normal but not low enough to qualify as osteoporosis.

Many people do not realize they have osteoporosis until they break a bone. Sometimes the fractures are major breaks, such as a broken hip or arm. In other cases, dozens or hundreds of tiny fractures may go unnoticed until a cumulative effect becomes obvious. Loss of height with aging, and the so-called dowager's hump (a severely rounded upper back), for example, are usually the result of many small osteoporotic fractures that have weakened the spine.

Risk Factors For Osteoporosis

Fortunately, osteoporosis is preventable. The first step in prevention is to recognize the risk factors for developing osteoporosis. In the following list of osteoporosis risk factors, the first one -- "Not enough calcium intake" -- is in bold, because this is a particular problem in patients with celiac disease.
  • Not enough calcium intake
  • Not enough vitamin D
  • Being thin or having a small frame
  • A family history of osteoporosis
  • Taking certain medications, such as glucocorticoids
  • Not enough weight-bearing exercise
  • Smoking
  • Drinking too much alcohol
  • In women: being postmenopausal, having an early menopause, or not having menstrual periods

Why People With Celiac Disease Are At High Risk For Osteoporosis

When people with celiac disease eat foods that contain gluten, the villi that line the small intestine are damaged. As a result, the nutrients in food cannot be absorbed properly by the body (a condition called "malabsorption"). Among the nutrients that are not well absorbed are calcium, vitamin D, and vitamin K, which are essential for healthy bones. Therefore, low bone density is common in children and adults with celiac disease. The risk of osteoporosis is especially high in celiac patients who were not diagnosed until adulthood (because they have gone longer without enough calcium and other nutrients).

In fact, the link between celiac disease and osteoporosis is so strong that researchers advise all patients who develop osteoporosis at a young age to get tested for celiac disease, to find out whether their low bone density is related to malabsorption. Sometimes, osteoporosis can be the only sign of celiac disease. Furthermore, researchers recommend that elderly patients with osteoporosis that doesn't seem to respond to medication should also be tested for celiac disease.

What You Need To Do First

The American Gastroenterological Association recommends that all patients with celiac disease undergo bone density tests to determine whether they have osteoporosis or osteopenia. These tests are quick, easy, and completely painless. They are often referred to as "bone density scans," "bone mineral density (BMD) tests," or "bone densitometry."

Your doctor will need to give you a prescription for a bone density test. There is no specific medical specialty for osteoporosis. In some hospitals, the department of endocrinology or metabolic bone disease performs the test. In other places, it may be the department of rheumatology, orthopedics or gynecology. Some hospitals have osteoporosis programs or women's health clinics that treat patients with osteoporosis.

Preventing And Treating Osteoporosis

Fortunately, when celiac patients adopt a gluten-free diet, their bone density usually improves. Your doctor may tell you that it's not your first bone density test that is most important, but rather, the ones you'll take every few years afterward, because these later ones will show how well your bones are responding to your intestines' improved ability to absorb nutrients.

In addition to avoiding gluten and having your bone density measured, keep the following issues in mind:

Get Enough Calcium and Vitamin D
Be sure your diet is rich in calcium as well as vitamin D, which helps your body absorb calcium. Good sources of calcium include low-fat dairy products as well as dark green, leafy vegetables and canned salmon. Vitamin D is synthesized in the skin through exposure to sunlight. The best way to get calcium is to eat foods that naturally contain it, but gluten-free calcium and vitamin D supplements can also help you meet your daily requirements. Ask your doctor which supplements would be best for you.

Exercise
Like your muscles, your bones will get stronger if you exercise. The best exercises for bones are those that force you to lift weight (even just the weight of your own body) as you work against gravity. Walking, stair climbing, and dancing are good. Weight training is even better. Exercise also strengthens the muscles that support your bones and improves your balance and flexibility, which not only makes it easier to keep exercising but also helps reduce your risk of falling and breaking a bone.

Avoid Smoking And Excessive Alcohol
Smoking is bad for bones, not to mention your heart and lungs. Heavy alcohol use is also bad for your bones. Heavy drinkers are more prone to low bone density (due to poor nutrition) and fracture (because of an increased risk of falling). It's important to quit smoking and limit your alcohol intake.

Talk With Your Doctor About Medication
Your doctor might recommend that you take medication for osteoporosis. Medications for prevention and treatment of osteoporosis include alendronate, risedronate, ibandronate, raloxifene, calcitonin, teriparatide and estrogen/hormone therapy.

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