Coeliac Disease and Osteoporosis
Impaired intestinal absorption of nutrients in coeliac disease may contribute towards deficiency of several nutrients, including calcium. Delayed diagnosis can lead to individuals presenting with osteopaenia or osteoporosis. As many as 50% of individuals with coeliac disease may develop osteoporosis and more than 75% of untreated adults with coeliac disease may have a reduce bone mineral density (BMD)1,2.
Clinical studies have demonstrated the role and importance of a gluten-free diet in normalisation of calcium absorption and improvement in bone mineral density3,4. However, the BMD may not return to that of the general population. It has also been suggested that individuals with coeliac disease, adhering to a gluten-free diet, may have a higher requirement for dietary calcium and therefore recommendations of calcium intake for the general population may be inadequate2. Subsequently, a strategy for the management of osteoporosis in coeliac disease was devised and this was recently updated5.
One of the benefits of treatment with a gluten-free diet of prepubertal, symptomatic children with coeliac disease is the potential for bone remineralisation6.
References
1. McFarlane XA, Bhalla AK, Reeves DE et al. Osteoporosis in treated adult coeliac disease. Gut 1995;36:710-714
2. Corazza GR, Di Stefano M, Mallrino E & Bai JC. Bones in coeliac disease: diagnosis and treatment. Best Practice & Research Clinical Gastroenterology 2005;19(3):453-465
3. Valdimarsson T, Lofman O, Toss G et al. Reversal of osteopaenia with diet in adult coeliac disease. Gut 1996;38:333-8
4. Corazza GR, DiSario A, Cecchetti A et al. Influence of pattern of clinical presentation and of gluten-free diet on bone mass and metabolism in adult coeliac disease. Bone 1996;18:525-530
5. British Society of Gastroenterolgy. Guidelines for osteoporosis in inflammatory bowel disease and coeliac disease. 2007
6. British Society of Paediatric Gastroenterology, Hepatology and Nutrition. Guideline for the diagnosis and management of coeliac disease in children. Coeliac Disease Working Group of BSPGHAN. 2006
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