Celiac disease, an autoimmune and inflammatory small bowel disease, impairs the body’s ability to absorb nutrients from food. The subsequent nutrient deficiency, that includes calcium and vitamin D crucial for strong bones, may result in a decrease in bone density. People with untreated celiac disease may develop a very low bone density, leading to a condition called osteoporosis (porous bones) that increases the risk of fractures. Low bone density is common in both children and adults affected by celiac disease. Hence, diagnosis and management of bone density loss in people with celiac disease are crucial in preventing premature bone fractures.

Understanding more about celiac disease

Celiac disease is an inherited digestive disorder that causes damage to the small intestine. It is caused by autoimmune reactions where the immune system attacks the body’s own tissue, in this case, the lining of the small intestine. The autoimmunity is triggered when gluten-containing foods like wheat, barley, and rye are consumed. These immune-mediated reactions lead to inflammation in the small intestine that causes damage to its small hair-like structures called villi. The damage disrupts the ability of the villi to absorb nutrients from the food into the bloodstream. 

In children and adults, untreated celiac disease can result in malnourishment leading to weight loss and anemia, and children may have delayed growth. Consuming gluten-containing foods may cause digestive symptoms more frequently in children than adults. These symptoms include diarrhea, stomach ache, bloating, flatulence, indigestion, and constipation.

The link between celiac disease and osteoporosis

Osteoporosis, which causes bones to become weak and brittle, is known to be a complication of celiac disease. Osteoporosis occurs due to the malabsorption of calcium and vitamin D in people with celiac disease. The small intestine is responsible for the absorption of important nutrients including calcium, vitamin D, and phosphorus that are vital for building and maintaining healthy bones. When children and adolescents are affected, celiac disease may hamper the development of adequate peak bone mass; and in adults, it causes bone loss. Research shows that untreated or newly diagnosed celiac disease may cause low bone density in both children and adults in spite of adequate calcium and phosphorus intake. 

Osteoporosis is a silent disease that may not cause any symptoms at its early stages. However, as the condition progresses, bone mass and bone mineral density decrease causing thin and weakened bones that are more prone to fractures. The bones become so weak that even a seemingly insignificant accidental fall, coughing, sneezing, or bending over to lift an object, can cause fractures.

The association between celiac disease and osteoporosis is so strong that doctors recommend every person who develops osteoporosis, particularly at a young age, be tested for celiac disease. This helps to determine whether malabsorption is the cause for their low bone density. Sometimes, osteoporosis that is revealed when a fracture occurs, may be the only indication that one has celiac disease as it may not always cause obvious symptoms. 

Management of celiac disease and osteoporosis

Fortunately, eliminating gluten-containing foods from the diet can help in managing celiac disease. The small intestine slowly regains the ability to absorb nutrients in a few months, and eventually bone density increases. In addition to following a gluten-free diet, people with celiac disease can follow a few strategies to improve bone health and prevent osteoporosis. These include: 

• Getting adequate calcium and vitamin D: It is essential to consume a diet rich in calcium and vitamin D. Calcium-rich foods include milk, cheese, and other dairy products, green leafy vegetables, and calcium-fortified beverages and foods. Vitamin D is vital for calcium absorption and can be obtained from foods such as egg yolks, fatty fish (salmon, tuna), liver, and fortified foods like yogurt and orange juice.
• Engaging in regular exercise: The best exercises for bones are weight-bearing and resistance exercises. Weight-bearing exercises include activities such as walking, dancing, or climbing stairs, while resistance exercises include lifting weights. These exercises help strengthen bones and the supporting muscles.
• Quitting smoking and limiting alcohol consumption: It is important to quit smoking as it is associated with a decrease in bone density and bone loss. Smoking is also associated with lower calcium absorption from the diet. Alcohol intake must be limited as excessive alcohol is known to accelerate bone loss.
• Taking a bone density test: The test helps to check the strength of bones and detect osteoporosis before a fracture occurs. In people with celiac disease, a bone density test helps to determine if medication is required to prevent or treat osteoporosis.

Conclusion

For people with celiac disease, it is crucial to understand the importance of a gluten-free diet in treating their underlying disease and to follow preventive strategies for osteoporosis. Osteoporosis should be suspected in people with celiac disease as it can help in the early diagnosis and prompt treatment of bone density loss. A combination therapy that includes a diet free of gluten and rich in calcium and vitamin D, regular exercise to strengthen bones, and following a healthy lifestyle can help prevent bone loss.

For any questions on bone health, you can: 

Speak to an Orthopedician