Osteoporosis in People With Celiac Disease

Osteoporosis and celiac disease commonly appear together. In fact, it's not unusual for someone in their 40s or even 30s to find they have low bone density immediately after they've been diagnosed with celiac disease.

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It's important to understand why this occurs (malnutrition related to intestinal damage from celiac disease seems to be the culprit). It's also important to know what you should do if you are diagnosed with both conditions.

What Is Osteoporosis?

The word "osteoporosis" is derived from Latin: "Osteo" is Latin for bone, and "porosis" is from a word meaning porous, or spongy.

Based on that, you might assume that "osteoporosis" means "spongy bones" or "porous bones"... and you'd be correct. Osteoporosis is a disease in which your bones are less dense than normal. The condition makes your bones more fragile and more likely to break. In a related condition, called osteopenia, bone density is lower than normal but isn't low enough to qualify as osteoporosis.

Many people do not realize they have osteoporosis until they break a bone. Sometimes the fractures involve 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, which is a severely rounded upper back. Medically titled kyphosis, dowager's hump is 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 controllable and uncontrollable risk factors for developing osteoporosis, according to the National Osteoporosis Foundation.

In the following list of both sets of osteoporosis risk factors, "Not enough calcium and vitamin D intake" is bold, because nutrient deficiencies are a particular problem in those with celiac disease.

  • Being over 50
  • Being female
  • Mesopause
  • Family history
  • Low body weight and size
  • Broken bones or height loss
  • Not enough calcium and vitamin D intake
  • Not eating enough fruits and vegetables
  • Consuming too much protein, sodium and caffeine
  • Lack of exercise
  • Smoking
  • Drinking excessive amounts of alcohol
  • Losing weight

Celiac Disease Is a Risk Factor for Osteoporosis

When people with celiac disease eat foods that contain the gluten protein, the villi that line the small intestine are damaged. As a result, the nutrients in their 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 celiacs who were not diagnosed until adulthood (because they have gone longer without absorbing enough calcium and other nutrients).

In fact, the link between celiac disease and osteoporosis is so strong that researchers advise everyone who develops 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 you discover when you break a bone can be the only indication you have celiac disease since celiac doesn't always cause obvious symptoms. Furthermore, researchers also recommend elderly people with osteoporosis who don't seem to respond to medication should be tested for celiac disease.

Osteoporosis Testing Urged

Celiac disease and bone density go hand in hand, with newly diagnosed celiac patients having up to a 75% chance of also having osteoporosis and osteopenia, according to Beyond Celiac. The non-profit organization reports that experts encourage celiac patients be tested and monitored for calcium and vitamin D deficiencies.

Tests to determine bone density and calcium and vitamin D deficiencies are quick, easy, and completely painless. They are often referred to as "bone density scans," "bone mineral density (BMD) tests," or "bone densitometry."

Your healthcare provider 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 people with osteoporosis.

Preventing and Treating Osteoporosis

Once most people are diagnosed with celiac disease and they start the gluten-free diet, their bone density usually improves. Your healthcare provider 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, you can take these steps to lower your risk for osteoporosis and osteopenia:

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 healthcare provider which supplements would be best for you.

Make Sure You Exercise

Like your muscles, your bones will get stronger if you exercise. The National Osteoporosis Foundation recommends different types of exercises including high-impact weight-bearing, low-impact weight bearing and muscle-strengthening.

High-impact weight-bearing exercises include:

  • Dancing
  • Doing high-impact aerobics
  • Hiking
  • Jogging/running
  • Jumping Rope
  • Stair climbing
  • Tennis

Low-impact weight-bearing include

  • Using elliptical training machines
  • Doing low-impact aerobics
  • Using stair-step machines
  • Fast walking on a treadmill or outside

Lastly, muscle-strengthening exercises include:

  • Lifting weights
  • Using elastic exercise bands
  • Using weight machines
  • Lifting your own body weight
  • Functional movements, such as standing and rising up on your toes

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.

A Word From Verywell

Your healthcare provider might recommend that you take medication for osteoporosis. There are various drugs on the market that are approved to treat low bone density, and it's possible that you might be a candidate to take a medication to treat your condition. Talk to your healthcare provider about the pros and cons of this approach.

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  1. Rai S, Kaur A, Chopra CS. Gluten-free products for celiac susceptible people. Front Nutrition. 2018;5:116. doi:10.3389/fnut.2018.00116

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