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  • Diana Gitig Ph.D.
    Diana Gitig Ph.D.

    Risk of Fracture in Celiac Disease: Gender, Dietary Compliance, or Both?

    Caption: Photo: CC - sebastianjt

    Celiac.com 11/23/2011 - Osteopenia and osteoporosis, both conditions in which bone density is less than optimal, are often seen in people with celiac disease at the time of their diagnosis. There have been conflicting data as to whether a gluten free diet can improve bone density. Researchers in Argentina set out to determine if celiac patients suffer more peripheral fractures than a control population, and to assess the effects of a gluten free diet on fracture risk. Their results are reported in the July 7, 2011 issue of the World Journal of Gastroenterology.

    Photo: CC - sebastianjtThey recruited 256 people who had been diagnosed with celiac at least five years before the study began in March, 2007, asked them if they had ever broken any bones and, if so, which. They then compared their answers to answers obtained from 530 age- and sex- matched controls with functional gastrointestinal disorders. People with other disorders that could reduce bone health – like thyroid dysfunction, rheumatoid arthritis, inflammatory bowel disease, and diabetes – as well as those taking vitamin D, steroids, calcium supplements or other medications that could affect bone metabolism were excluded.

    They found that celiacs had a higher rate and risk of first peripheral fracture before diagnosis – but this effect only achieved statistical significance for men. This increased risk was also associated with a classical clinical presentation; those with atypical or silent forms of celiac did not exhibit the same risk. Although the finding that being male increases a celiac’s risk of peripheral fractures is intriguing, it must be borne out by larger studies – only 42 of the 256 celiacs included in this study were male. After maintaining a gluten free diet for five years, the elevated risk of fractures was gone.

    The authors speculate that eliminating gluten may reduce the risk of fractures in celiac patients not necessarily by increasing bone mass and mineral density, but by improving body mass and fat/ muscle composition, nutritional status, and bone architecture.

    Despite its limited scope, the take home message of this study is clear; if you have celiac disease, strictly adhering to a gluten free diet is good not just for your intestines, immune system, and skin; it is also good for your bones.

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  • About Me

    Diana received her B.A. in Biochemistry from the University of Pennsylvania, and then a Ph.D. in Cell Biology and Genetics from Cornell. Now she is a freelance science writer and editor in White Plains, New York.  Her son was diagnosed with celiac disease in 2006, at the age of five, and she has been keeping her family healthy by feeding them gluten free treats ever since.

  • Related Articles

    Scott Adams
    Pediatrics 2001;108:e89
    Celiac.com 01/14/2002 - According to a report in the electronic version of Pediatrics for November 2001, Osteopenia is often found in children with untreated celiac disease. A strict gluten-free diet will promote an increase in bone mineral density (BMD) values, but even after a year of treatment they may not return to normal. In their study, Dr. Ayhan Gazi Kalayci, of Ondokuz Mayia University, Samsun, Turkey, and colleagues evaluated 32 children with celiac disease and 82 healthy control subjects. The patients were separated into two groups of 16, one that consisted of patients who had been recently diagnosed (within the average of 3.2 years), and the other which consisted of patients who had followed a strict gluten-free diet for 19 to 84 months.
    Results: Patients with recently diagnosed celiac disease had significantly lower BMD and bone mineral content levels than control subjects, and the BMD levels increased significantly after one year on a gluten-free diet. According to Dr. Kalayci, more follow-up studies will be needed to determine whether re-mineralization will continue in the subjects, and a complete recovery of bone mass can be achieved.

    Scott Adams
    International Osteoporosis Foundation and National Osteoporosis Foundation 2005 - Received: 31 March 2004 / Accepted: 30 November, 2004 / Published online: 4 February 2005. Michael W. Davie, I. Gaywood, E. George, P.W. Jones, T. Masud, T. Price, G.D. Summers. International Osteoporosis Foundation and National Osteoporosis Foundation 2005 - Received: 31 March 2004 / Accepted: 30 November, 2004 / Published online: 4 February 2005. Celiac.com 04/27/2006 - Because recent studies may have underestimated the association of celiac disease with fracture by studying patients with low fracture risk, doctors recently conducted a more comprehensive survey of celiac and non-celiac patients.
    Their study of post-menopausal women over age 50 concluded that women diagnosed with celiac disease face an increased risk of fracture over time compared with control groups. The study looked at non-spinal fracture risk associated with celiac patients and non-celiac control groups in relation to the time-periods before and after the diagnosis of celiac disease.
    According to the study, Celiac patients displayed greater fracture prevalence (odds ratio [OR], 1.51), confidence interval [CI], 1.13:2.02) and fracture after 50 years (OR, 2.20; CI, 1.49:3.25). The study compared Three hundred and eighty-three female celiac patients with 445 female controls, all over 50 years old. The mean age of celiacs tested was 61.4-67.8 years, and 62.7-69.9 years in controls. The celiac patients generally weighed less than the control patients of the same height.
    Among celiac patients diagnosed after age 50, no excess fracture risk was found in the period more than 10 years before diagnosis, but risk increased in the period from 10 years before diagnosis to 5 years after and remained high more than 5 years after diagnosis (p
    Adjusted for height and weight, instance of wrist fracture between the groups was about the same, but celiacs did have more multiple fractures (OR, 2.96; CI, 1.81:4.83). Further, while women diagnosed before age fifty, showed no excess fracture risk, those celiac patients more than five years beyond their diagnosis faced increased risk of wrist fractures ( p
    While women diagnosed with celiac disease before age 50 faced no greater risk than their non-celiac peers, for those diagnosed after age fifty, the risk of fracture increases as the years pass, with the greatest statistical increase occurring five to ten years after a diagnosis.
    Accordingly, thin women over 50 who suffer from multiple fractures should consider being tested for celiac disease. If the diagnosis is positive, they should take measures to ensure proper calcium and vitamin D intake.

    Jefferson Adams
    Celiac.com 11/05/2009 - It's well known that people with celiac disease often show reduced bone mineral density, and that metabolic bone disease is a significant and common complication of celiac disease. A new article in the journal Nutrition Reviews reinforces the benefits of a gluten-free diet in reducing bone problems in children with celiac disease.
    This is important information, because, even though celiac disease can be diagnosed at any age, it most often discovered in children between 9 and 24 months of age.
    By better understanding the benefits of a gluten-free diet in preventing bone disease, parents can make smarter choices that will help build healthy bones in their celiac kids.
    Ideally, this will help the kids to avoid the reduced bone mineral density that can lead to the inability to develop optimal bone mass as children and to the loss of bone as adults, both of which increase the risk of osteoporosis, and contribute to an additional risk of fracture.
    The good news is that the evidence suggests that a gluten-free diet in celiac children paves the way for a rapid increase in bone mineral density, followed by a complete recovery of bone mineralization. Children may attain normal peak bone mass if the diagnosis is made and treatment is given before puberty, thereby preventing osteoporosis in later life.
    Also, regular calcium and vitamin D supplements seem to increase the bone mineral density of children and adolescents with celiac disease.
    In adults, the picture is less rosy. In adults, a gluten-free diet improves, although rarely normalizes, bone mineral density.
    "Our findings reinforce the importance of a strict gluten-free diet, which remains the only scientific proven treatment for celiac disease to date," the authors conclude. "Early diagnosis and therapy are critical in preventing celiac disease complications, like reduced bone mineral density."
    Source:
    Nutrition Reviews


    Jefferson Adams
    Celiac.com 03/11/2011 - At the December 2010 Annual Conference of the Endocrine Society of India (ESICON), Dr. Ameya Joshi presented a paper on the reduced bone density, and elevated risk of bone fracture faced by people with both celiac disease and type 1 diabetes. The paper was awarded second prize among conference presentations.
    Dr. Joshi's research was conducted under the auspices of the endocrinology department of BYL Nair Hospital, and the supervision of department head, Premlata Varthakavi.
    In his recent study, Dr. Joshi found that people with both celiac disease and type 1 diabetes have been found to have poor bone mineral density, making them susceptible to fractures.
    For his study, Dr. Joshi's research team tested 80 type 1 diabetics. They found that 11 of the 80 patients had celiac disease.
    A control group of 22 patients suffered from type 1 diabetes without celiac disease. Patient ranged in age from 12 years to 40 years.
    “While many suffer from typical symptoms such as gastrointestinal problems, others suffer from fractures from unrecognized trauma,” said Dr Joshi, adding, “Simple dietary measures can reverse these symptoms and improve bone density.”
    While similar research has been done in the West, this is the first study by an Indian research team to show a correlation between celiac disease and low bone mineral density in type 1 diabetics.


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