Bone Density and Celiac Disease

Raul Ruiz Esponda, M. D., discusses the connection between bone density and celiac disease.

Celiac disease and bone health is a very important topic. Bone loss is important because it may lead to osteoporosis and fractures. Fractures can lead to morbidity and in some cases, mortality. It is important to detect boss loss and make sure celiac disease patients are taking care of their bone health. There are several reason why someone with celiac disease may have bone loss. Malabsorption and inflammation are two of the main reasons for bone loss for celiac disease patients. Malabsorption of calcium leads to secondary hypoparathyriodism. When calcium levels are detected as low in the blood, parathyroid hormone (PTH) is secreted. In situations like celiac disease where malabsorption is occurring, the parathyroid hormone plays an important role in bone reabsorption in order to receive calcium within normal limits leading to decreased bone density or bone wasting. Some studies have shown that in patients with celiac disease the higher the level PTH, the lower the level of bone density at the hip and the spine. This correlation explains and ties together how patients lose bone density when they have celiac disease. Another important factor is inflammation. This interferes with bone reabsorption. Other less known factors include lower levels of physical activity, lower body mass indexes, early menopause, and decreased levels of growth hormone. All of these are factors for bone loss. Bone density is used as a surrogate marker for fractures. Studies that have compared celiac disease patients with healthy controls have shown celiac disease patients at diagnosis have lower bone densities at the hip and spine. Similar studies have also shown bone density correlates with damage at the gastrointestinal level. This means the more malabsorption, the lower the bone density. Pulling the reports together, 50-70% of patients with celiac disease will have some type of low bone density. Studies examining fractures have shown celiac disease patients are at a 30% higher risk of having a fracture. So what can we do about this? A gluten-free diet has shown to increase bone density by 8% in the first year. After being on a gluten-free diet for one year, physicians may consider putting patients on medication for osteoporosis. The number of vitamin D and calcium supplements a celiac disease patient needs a day varies from patient to patient.

For more information about celiac disease, visit mayoclinic.org/celiacdisease.