Celiac.com 03/13/2026 - People with celiac disease have a higher risk of weak bones and fractures. A gluten-free diet can help bone health improve over time, but many adults still face a long-term fracture risk, which is why early bone screening matters. The challenge is that medical guidelines do not fully agree on when a first bone density test should happen. This study looked at a large group of adults with newly diagnosed celiac disease to help answer a practical question: when is the best time to do the first dual-energy x-ray absorptiometry scan, depending on what a doctor is trying to accomplish?

What the Researchers Studied

The researchers followed 627 adults older than 25 years with a new diagnosis of celiac disease who completed dual-energy x-ray absorptiometry scans of the lumbar spine and hip within one year of diagnosis as part of routine care. They collected information about symptoms, blood test results, small intestine biopsy findings, and fracture risk factors. They then analyzed which patients had low bone density for their age, which patients met criteria for osteoporosis, and how well a risk-based approach could reduce unnecessary scans.

The study group was mostly female (about 78 percent) and the average age was about 42 years. Many participants had signs that can go along with nutrient malabsorption, including iron deficiency, diarrhea, and weight loss.

How Bone Health Was Measured

Bone mineral density results from dual-energy x-ray absorptiometry are commonly reported using two comparison scores. One score compares a person to others of the same age and sex, which helps identify bone density that is unusually low for age. Another score compares a person to a young adult reference group, which helps identify osteoporosis. The researchers used standard thresholds to classify “low bone mineral density for age” and “osteoporosis,” and they also created a combined measure of “clinically relevant bone mineral density alterations” that better reflects how clinicians interpret results across different ages and menopause status.

Main Results: Low Bone Density Can Show Up Early

Low bone mineral density for age was found in 17.2 percent of the full group. Importantly, it was already present in younger adults: 13.4 percent of people aged 25 to 34 had low bone mineral density for age. The rate rose in midlife, reaching 22.9 percent in the 45 to 54 age group and about 26.5 percent in the 55 to 64 age group.

Several factors were linked to low bone mineral density for age. People who had weight loss, were underweight, or had iron-deficiency anemia at diagnosis were more likely to have low bone density for age. Male sex was also associated with higher odds of low bone density for age in the study’s risk modeling.

Main Results: Osteoporosis Becomes Much More Common After Midlife

Osteoporosis was found in 17.9 percent of participants overall. Unlike low bone mineral density for age, osteoporosis was less common in younger adults and then increased sharply in later decades. In the 25 to 34 age group, osteoporosis was about 5.5 percent, and in the 35 to 44 age group it was about 7.6 percent. After that, rates rose quickly: about 27.1 percent in ages 45 to 54, about 47.1 percent in ages 55 to 64, and more than half in those 65 and older.

Risk factors tied to osteoporosis included older age and signs of malabsorption at diagnosis, especially weight loss and being underweight. Interestingly, female sex itself was not linked to higher odds of osteoporosis in this dataset once other factors were considered.

What About Fracture Risk Tools and “Targeted” Screening?

Some guidelines recommend using a risk calculator first and reserving bone scans for people whose calculated risk is high enough. In this study, the researchers tested how well an approach based on the National Osteoporosis Guidelines Group could reduce unnecessary scans while still identifying people who truly need treatment.

Using this risk-based approach, about 67 percent of patients would have been able to avoid an initial bone scan. Among those classified as low risk before scanning, only about 0.5 percent would have been “missed” in the sense that they later crossed the treatment threshold once bone density was added into the fracture risk calculation.

However, there was a tradeoff. Even among the people who fell below the assessment threshold (meaning the guidelines would not have recommended a scan), the study still found meaningful bone problems: 15.7 percent had low bone mineral density for age and 10.0 percent had osteoporosis. In addition, 16.2 percent had “clinically relevant bone mineral density alterations” by the study’s combined definition.

What the Study Suggests About “Best Timing”

The researchers argue that the best timing depends on the goal and the resources of the health system. If the goal is early detection of bone loss (catching problems even in younger adults), then doing a dual-energy x-ray absorptiometry scan at the time of celiac disease diagnosis makes the most sense, because low bone mineral density for age was already common in people aged 25 to 34.

If the goal is to identify osteoporosis specifically, the results point toward starting routine screening around age 45, or earlier when additional risk factors are present, such as weight loss or being underweight. This is because osteoporosis rates rose sharply after age 45 in the study group.

If the goal is to focus only on high fracture risk and reduce testing burden, then a fracture-risk-first strategy like the National Osteoporosis Guidelines Group approach can help avoid many scans with a very small chance of missing people who meet treatment thresholds. But the study emphasizes that this approach may delay recognition of bone density problems that are still clinically relevant, especially in younger patients.

Why This Matters for People With Celiac Disease

This study highlights a key reality: bone health issues in celiac disease are not just an older-adult problem. A notable portion of younger adults already have bone density that is too low for their age at the time they are diagnosed. At the same time, osteoporosis becomes far more common after midlife, especially after age 45.

For the celiac community, the takeaway is practical. If you are newly diagnosed, it may be worth discussing bone density testing early, especially if you have warning signs like weight loss, low body weight, or iron-deficiency anemia. If your healthcare system uses a risk calculator approach to limit scans, this study suggests it can reduce unnecessary testing, but it may also miss early bone loss that could benefit from lifestyle changes, nutrition support, and closer follow-up. In short, the “best” screening plan is not one-size-fits-all: it should match the person’s age, symptoms, and risk factors, with the goal of preventing fractures and protecting long-term health.

Read more at: journals.lww.com

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Celiac.com 10/16/2025 - People living with celiac disease face more than just the challenge of avoiding gluten. This condition, which causes the immune system to attack the small intestine after eating gluten, can lead to long-term complications if untreated. One of the most concerning complications is the increased risk of osteoporosis and bone fractures. Because of this, many healthcare providers recommend that patients undergo bone mineral density testing, often with a scan called Dual Energy X-ray Absorptiometry (DXA). However, doctors have debated the best time to perform this test. Should it be done right when celiac disease is diagnosed, or later in life? This study set out to answer that question by carefully analyzing bone health in hundreds of patients with celiac disease.

How the Study Was Conducted

The researchers followed 627 adults with celiac disease, all over the age of 25. Each person had DXA scans performed on the spine and hip, which are the most common areas for osteoporosis to develop. Along with bone density results, the team collected detailed information on each patient’s medical history, including symptoms, blood test results, intestinal biopsy findings, and known risk factors for weak bones. They also evaluated the usefulness of a well-known set of guidelines, called the National Osteoporosis Guidelines Group (NOGG), which are designed to reduce unnecessary scans by identifying only those patients most at risk.

To dig deeper, the researchers used statistical tools to find out which factors were most strongly linked to low bone mineral density and osteoporosis. They also looked at fracture risk and how different screening strategies might change the ability to detect bone weakness early or prevent future fractures.

Key Findings

The results showed that low bone mineral density was fairly common among people with celiac disease. Overall, 17.2 percent of patients had bone density lower than expected for their age. Surprisingly, this was not limited to older adults. Even patients in their late twenties and early thirties showed a notable prevalence of weaker bones, at about 13.4 percent. As expected, the problem grew worse with age, with the 45-to-54-year-old group showing an even higher rate of bone density loss.

Osteoporosis, which is more severe than low bone density, was diagnosed in nearly 18 percent of all patients. Once again, the likelihood of having osteoporosis was much higher in patients over 45 years old. Risk factors that made osteoporosis or low bone density more likely included weight loss, being underweight, and iron deficiency anemia, all of which are fairly common in celiac disease.

When the researchers applied the NOGG guidelines, they found that more than two-thirds of the patients could have skipped the DXA scan. However, this approach had trade-offs. While it reduced unnecessary scans, it also risked missing almost 16 percent of patients who had low bone density for their age and might benefit from treatment or closer monitoring. On the other hand, the chance of missing someone with severe bone loss requiring immediate treatment was very small, less than one percent.

Balancing Early Detection and Practical Care

The study highlights that there is no single “perfect” time to do bone density screening for people with celiac disease. Instead, the decision depends on what the healthcare team is trying to achieve. If the goal is to find bone weakness as early as possible, then performing a DXA scan right at the time of diagnosis is the most effective option. This ensures that even younger adults who may already have weaker bones are identified quickly.

However, if the main concern is preventing fractures and focusing medical resources on the highest-risk patients, then using the NOGG criteria can be a practical solution. This approach allows doctors to avoid scanning many patients unnecessarily while still catching those most likely to experience bone fractures. The drawback is that some cases of early bone weakness may be overlooked.

The researchers suggest that healthcare providers may need to tailor their approach depending on available resources, the age of the patient, and other risk factors. For example, a younger patient who is underweight or who has severe anemia may still benefit from an early DXA scan, while an older patient may fall more clearly under the NOGG-based strategy.

Why This Matters for People With Celiac Disease

For individuals living with celiac disease, this study carries an important message. Weak bones and fractures are not just concerns for the elderly. Even younger adults with celiac disease can show early signs of bone problems. Because of this, patients should talk openly with their doctors about bone health, especially if they have experienced weight loss, anemia, or other risk factors that suggest weaker bones. In many cases, a simple DXA scan could provide valuable information and lead to preventive treatment before fractures occur.

For patients already following a gluten-free diet, understanding bone health is another crucial part of managing celiac disease. This study shows that the timing of screening can make a difference and that a thoughtful, personalized approach works best. Patients who take charge of their bone health, together with their healthcare team, can reduce the risk of painful and life-altering fractures.

Conclusion

This study provides valuable insight into when bone density screening should be performed in people with celiac disease. The findings suggest that early scanning helps identify hidden cases of low bone density, especially in younger adults, while guidelines like those from NOGG can reduce unnecessary testing but may overlook milder cases. The message is clear: there is no one-size-fits-all approach. Instead, the best strategy is to consider each patient’s age, health status, and risk factors. For those with celiac disease, awareness and early action can play a critical role in protecting bone health and preventing fractures later in life.

Read more at: journals.lww.com

Celiac.com 06/05/2025 - Osteoporosis, a condition where bones become weak and more prone to fractures, is a major health concern for people with celiac disease. Since fragile bones can lead to serious injuries, it is important to know when to start checking bone health in individuals with this autoimmune condition. This study aimed to find the best age to begin screening for osteoporosis among adults with celiac disease, helping doctors catch problems early and offer treatments that could prevent fractures.

How the Study Was Designed

Researchers carried out a cross-sectional study, which means they collected data from a large group of people at a single point in time. The participants were adults with newly diagnosed celiac disease who visited a specialized center between 2015 and 2020.

To focus specifically on how celiac disease affects bone health, the study excluded anyone with other risk factors that could confuse the results, such as smoking, menopause, steroid medication use, or endocrine problems. Only individuals 25 years or older were included.

At diagnosis, before starting a gluten-free diet, all participants had their bone density measured using a special scan called DXA. This scan focused on the lumbar spine (lower back), a common area affected by osteoporosis. Depending on the participant’s age and sex, either a T-score or Z-score was used to determine if their bone density was lower than expected.

Participants were grouped into four age ranges:

• 25–35 years old
• 35–45 years old
• 45–55 years old
• 55–70 years old

This grouping helped the researchers see how the risk of osteoporosis changed as patients got older.

Who Participated in the Study

The study included 199 adults diagnosed with celiac disease. About 28 percent were men and 72 percent were women. Their average age was around 39 years old. At the time of their diagnosis, roughly 24 percent of them already had osteoporosis affecting their lumbar spine.

Interestingly, women made up the majority of those with osteoporosis, but the difference between men and women was not found to be statistically significant. Other factors such as body weight, blood levels of vitamin D, and specific markers related to celiac disease also did not show strong differences between those with and without osteoporosis.

What the Results Showed

When the researchers compared the different age groups, they found that osteoporosis was not evenly distributed across all ages. People between 45 and 55 years old had a notably higher chance of having osteoporosis compared to those aged 25 to 35.

Even after considering other possible influences, such as sex, body weight, and blood sugar problems (like diabetes), the pattern stayed the same. Those aged 45–55 had about a 22 percent greater chance of osteoporosis than the youngest group studied.

There was also some suggestion that those older than 55 might be at higher risk, but this finding was not as strong once the researchers adjusted for other health factors.

Overall, no significant link was found between osteoporosis risk and factors like body mass index, presence of type 2 diabetes, or the severity of intestinal damage caused by celiac disease.

Understanding the Connection Between Age and Bone Health

The results suggest that middle age — specifically between 45 and 55 years old — is a crucial time when people with celiac disease become more vulnerable to bone weakening. Although bone loss can happen at any age, it seems to become significantly more likely during this middle age window for celiac patients.

This finding is important because early osteoporosis may not cause any symptoms until a fracture occurs. Routine bone screening beginning around age 45 could detect low bone density early and allow for treatments that help strengthen bones and prevent injuries.

Final Thoughts and Why This Matters for Celiac Disease

This study provides valuable information for anyone living with celiac disease. Even though many people with celiac disease focus on managing their diet to control digestive symptoms, it is equally important to pay attention to the long-term impacts of the disease on overall health — including bone health.

By recommending that bone density screenings begin at age 45 for people with celiac disease, this research offers a practical step toward preventing fractures and maintaining a better quality of life. This advice is especially meaningful because osteoporosis often develops silently, without obvious symptoms, until a major fracture occurs.

For patients and doctors alike, this study highlights the need for a more proactive approach to bone health in celiac disease management. Screening early means treatment can begin early, helping to prevent serious and even life-threatening complications.

Read more at: researchgate.net

Celiac.com 02/03/2025 - Bone health is a significant concern for individuals with celiac disease, a condition that extends beyond the digestive system to affect the entire body. This study sheds light on how celiac disease impacts bone mineral density, body composition, and levels of key nutrients like vitamin D and calcium. By comparing women with celiac disease to healthy individuals, researchers provide insights into the broader implications of the disease on skeletal and overall health.

Key Focus: Bone Mineral Density in Celiac Disease

Bone mineral density refers to the strength and density of bones, which are vital for preventing conditions like osteopenia and osteoporosis. These conditions weaken bones, making them more prone to fractures. In this study, researchers used a specialized imaging technique called dual-energy X-ray absorptiometry to measure bone density at two critical sites: the lumbar spine and the femoral neck.

Women with celiac disease demonstrated significantly lower bone mineral density than their healthy counterparts. Specifically, over one-third of participants with celiac disease had osteopenia in the lumbar spine, while 13% had osteoporosis. The femoral neck, however, showed lower rates of osteoporosis but still indicated a decline in bone health. Despite these findings, none of the women in the study reported a history of fractures, suggesting that bone fragility may develop silently over time.

Body Composition Differences

Celiac disease also affects body composition, which includes body mass, fat tissue, muscle mass, and fat-free mass. Women with celiac disease in this study had lower body mass and body mass index than healthy participants. Additionally, their levels of fat and muscle tissue were reduced, potentially reflecting long-term nutritional deficiencies and malabsorption issues commonly associated with the disease.

These findings align with the nature of celiac disease as a condition that disrupts nutrient absorption in the intestines. While some individuals with newly diagnosed celiac disease may present with normal or elevated body mass, many still experience undernutrition and its associated consequences.

The Role of Vitamin D and Calcium

Vitamin D and calcium are critical for maintaining bone health. The study highlighted significant differences between the groups in how these nutrients were managed. Women with celiac disease were more likely to take vitamin D and calcium supplements than healthy individuals. As a result, their blood levels of vitamin D were higher, though no significant differences were observed in ionized calcium levels between the groups.

Despite the higher supplementation rates, the prevalence of low bone density remained higher among participants with celiac disease. This suggests that while supplementation helps improve nutrient levels in the blood, it may not fully address the bone health challenges associated with the disease.

Insights into Bone Health Screening and Management

The study underscores the importance of early screening and monitoring of bone health in individuals with celiac disease. Bone mineral density assessments using dual-energy X-ray absorptiometry can identify early signs of osteopenia or osteoporosis, even in patients without symptoms.

Additionally, the findings suggest that simply taking supplements may not be enough to counteract the effects of long-term nutrient deficiencies caused by celiac disease. A comprehensive approach, including a strict gluten-free diet to reduce inflammation, physical activity to strengthen bones, and potentially tailored medical treatments, could provide better outcomes.

Why This Matters for People with Celiac Disease

Celiac disease is more than a condition requiring dietary changes; it has wide-reaching effects on overall health, including bone strength. This study highlights the need for increased awareness of these issues among patients and healthcare providers.

For individuals with celiac disease, understanding the risks to bone health can encourage proactive steps, such as regular bone density scans, diligent vitamin D and calcium supplementation, and adherence to a gluten-free diet to improve nutrient absorption. These measures can help prevent serious complications like osteoporosis and ensure better long-term health.

This research provides valuable evidence that celiac disease’s impact extends far beyond the gut. By addressing these systemic challenges, those living with celiac disease can lead healthier and more resilient lives.

Read more at: termedia.pl

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Celiac.com 06/06/2023 - Celiac disease, osteopenia  and osteoporosis are conditions that have been found to be connected. A research team recently described celiac disease-induced osteoporosis in an attempt to enlighten new and lesser-known aspects, including the influence of the intestinal microbiome and sex-related differences, on bone health. 

The team included Lisa Lungaro, Francesca Manza, Anna Costanzini, Marianna Barbalinardo, Denis Gentili, Fabio Caputo, Matteo Guarino, Giorgio Zoli, Umberto Volta, Roberto De Giorgio, and Giacomo Caio.

They are variously affiliated with the Department of Translational Medicine, University of Ferrara in Ferrara, Italy; the National Research Council, Institute for the Study of Nanostructured Materials (CNR-ISMN) in Bologna, Italy; the Department of Medical and Surgical Sciences, University of Bologna, in Bologna, Italy; the Mucosal Immunology and Biology Research Center, Massachusetts General Hospital—Harvard Medical School in Boston, MA, USA.

Their review describes the role of celiac disease in the development of skeletal alterations, in order to provide physicians with an updated overview on this debated topic, and to improve the management of osteoporosis in celiac disease.

It is important to note that not all individuals with celiac disease will develop osteoporosis. The risk varies depending on factors such as the duration and severity of the disease, adherence to a gluten-free diet, and individual variations in bone health and genetics. 

However, individuals with celiac disease should be aware of the increased risk of osteoporosis and take steps to manage their bone health, including ensuring adequate calcium and vitamin D intake, monitoring bone density through regular screenings, and maintaining strict adherence to a gluten-free diet. 

Several important connections between the conditions highlighted by the researchers include:

Malabsorption

Celiac disease is characterized by damage to the small intestine, leading to impaired absorption of nutrients, including calcium and vitamin D, which are essential for maintaining healthy bones. Malabsorption of these nutrients can result in reduced bone mineral density and increased risk of osteoporosis.

Inflammatory Response

Celiac disease triggers an immune response in the presence of gluten. This immune response involves the production of pro-inflammatory molecules, which can contribute to bone loss and increased bone turnover, leading to osteoporosis.

Calcium Imbalance

The malabsorption of calcium in individuals with celiac disease can disrupt the balance of calcium in the body. When there is insufficient calcium intake or absorption, the body may draw calcium from the bones, weakening them and increasing the risk of osteoporosis. Calcium intake in the young age is an essential determinant of the bone mass peak. Calcium metabolism defects are common in untreated children with celiac disease, and they return to normal with a gluten-free diet.

Vitamin D Deficiency

Vitamin D plays a crucial role in calcium absorption and bone health. Celiac disease can lead to reduced vitamin D absorption due to intestinal damage. Vitamin D deficiency further exacerbates the risk of osteoporosis.

Gluten-Induced Autoimmunity

Celiac disease is an autoimmune disorder, and individuals with autoimmune diseases, including celiac disease, have a higher risk of developing additional autoimmune conditions such as autoimmune osteoporosis. Autoimmune mechanisms may contribute to bone loss and the development of osteoporosis in individuals with celiac disease.

Hormonal Imbalance

Celiac disease can disrupt the endocrine system, leading to hormonal imbalances. Hormones such as estrogen and testosterone play a crucial role in maintaining bone health. Imbalances in these hormones can accelerate bone loss and increase the risk of osteoporosis.

Sex Differences

Women with celiac disease are at a higher risk of osteoporosis due to both indirect and direct effects. The indirect effects include factors such as early menopause and amenorrhea (absence of menstruation), which can have a negative impact on bone health. Early menopause refers to the cessation of menstruation before the age of 45, which can occur in women with celiac disease due to various factors, including hormonal imbalances and inflammation.

Early menopause is concerning for bone health because estrogen, a hormone that helps maintain bone density, decreases significantly during menopause. Lower estrogen levels can accelerate bone loss and increase the risk of osteoporosis. Therefore, women with celiac disease who experience early menopause should be particularly vigilant about managing their bone health.

Physicians should be aware of bone conditions linked to celiac disease that might contribute to the worsening of BMD, and should treat them promptly. 

There is little evidence regarding osteopenia and pharmacological osteoporosis treatment, specifically in celiac disease. Probiotic supplementation might become a novel strategy in preventing bone alterations, although the role of gut microbiota is still uncertain and not well-established yet. 

In the full report, the researchers offer a comprehensive dive into each of the areas mentioned above.

Read more in Nutrients. 2023 Mar; 15(5): 1089
doi: 10.3390/nu15051089

Celiac.com 05/03/2021 - Some research data suggests that a vegan diet may be associated with impaired bone health. To get an idea of the potential impact of a vegan diet on bone mass, a team of researchers recently set out to investigate the associations of veganism with calcaneal quantitative ultrasound (QUS) measurements, along with the investigation of differences in the concentrations of nutrition- and bone-related biomarkers between vegans and omnivores.

Scientific evidence suggests that a vegan diet might be associated with impaired bone health. The team used a cross-sectional study of 36 vegans, and 36 omnivores to assess the associations between a vegan diet and calcaneal quantitative ultrasound (QUS) measurements, along with comparing concentrations of nutrition- and bone-related biomarkers between vegans and omnivores. 

The data showed lower QUS parameters in vegans compared to omnivores. For example, broadband ultrasound attenuation shows a low QUS parameter of 111.8 ± 10.7 dB/MHz for vegans, compared with 118.0 ± 10.8 dB/MHz for omnivores. 

Compared with omnivores, vegans had lower levels of vitamin A, B2, lysine, zinc, selenoprotein P, n-3 fatty acids, urinary iodine, and calcium, but higher concentrations of vitamin K1, folate, and glutamine. 

Applying a reduced rank regression, the team found 12 out of the 28 biomarkers that contribute most to bone health, including lysine, urinary iodine, thyroid-stimulating hormone, selenoprotein P, vitamin A, leucine, α-klotho, n-3 fatty acids, urinary calcium/magnesium, vitamin B6, and FGF23. They found that all QUS parameters rose across the tertiles of the pattern score. 

The study offers evidence of reduced bone health in vegans compared to omnivores, in addition to highlighting a combination of nutrition-related biomarkers, which may reduce bone health. The team calls for additional studies to confirm these findings.

Since a number of studies have shown celiacs to be at greater risk for reduced bone health, especially bone density, bone health is a major concern for people with celiac disease. Learning more about the role of diet in improving bone health will benefit celiacs and non-celiacs alike.

Read more in Nutrients 2021, 13(2), 685.
 

The research team included Juliane Menzel, Klaus Abraham,Gabriele I. Stangl, Per Magne Ueland, Rima Obeid, Matthias B. Schulze, Isabelle Herter-Aeberli, Tanja Schwerdtle, and Cornelia Weikert. They are variously affiliated with the Department of Food Safety, German Federal Institute for Risk Assessment in Berlin, Germany; the Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin in Berlin, Germany; the Institute for Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; the Section for Pharmacology, Department of Clinical Science, University of Bergen in Bergen, Norway; the Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany; the Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam–Rehbruecke, Nuthetal, Germany; the Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; the Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich in Zurich, Switzerland; the German Federal Institute for Risk Assessment, Berlin, Germany; and the Department of Food Chemistry, Institute of Nutritional Science, University of Potsdam in Nuthetal, Germany.

Celiac.com 10/23/2020 - As people age, their bones become less dense, and their risk of developing osteoporosis, leaving them susceptible to fractures. A recent study indicates that celiac disease may increase that risk, even in younger people. 

According to the Canadian study, people with celiac disease have a higher risk of serious osteoporotic fracture that is unrelated to their fracture risk assessment tool (FRAX) score. FRAX scores accurately predict fracture risk when celiac disease is added as a secondary osteoporosis risk factor, or when BMD is included in the FRAX assessment.

A research team used data from the Manitoba Bone Mineral Density Registry to determine the 10-year risk of major osteoporotic fractures in nearly 700 people with celiac disease, over a period of about seven years. They also followed just over 68,000 people from the general population subjects for a similar period. The research team included D.R. Duerksen, L.M. Lix, H. Johansson, E.V. McCloskey, N.C. Harvey, J.A. Kanis & W.D. Leslie.

The team found that about 8.5 percent of people in each group suffered one or more major osteoporotic fractures, even though the celiac disease group was younger, and contained more men.

In the general population, there FRAX predictions and the observed 10-year major osteoporotic fracture probabilities matched up cleanly. In patients with celiac disease, however, predicted and observed fracture predictions only aligned when celiac disease was factored as secondary osteoporosis; otherwise, FRAX underestimated the celiac patients' 10-year major fracture risk by more than 4 percent.

Celiac disease patients face an increased risk of major osteoporotic fractures. When celiac disease is considered as a secondary osteoporosis risk factor, or when BMD is included in FRAX assessment, FRAX can accurately predict future fracture risk.

Do you have celiac disease and also suffer from osteoporosis? Have you broken bones? Share your thoughts below.

Read more in Osteoporosis International (2020)

Celiac.com 10/28/2019 - Among other things, a recent study on nutrition and bone health in adults with probable undiagnosed, untreated celiac disease drives home the importance of early diagnosis and quick adoption of a gluten-free diet. The importance can be seen in the findings of a research team that recently looked at variations in nutritional intake of calcium, vitamin D, and phosphorus; their levels in the blood; and bone health in adults with and without likely, undiagnosed celiac disease.

The research team included Lara H. Sattgast, Sina Gallo, Cara L. Frankenfeld, Alanna J. Moshfegh, and Margaret Slavin. They are variously affiliated with the Department of Nutrition & Food Studies, George Mason University, Fairfax, Virginia, USA; the Department of Global & Community Health, George Mason University, Fairfax, Virginia, USA; and the Food Survey celiac diseases Research Group, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland, USA.

The team analyzed data from 48 adults with likely undiagnosed celiac disease and positive immunoglobulin A endomysial antibody tests, and 13,634 controls. The data came from What We Eat in America and the National Health and Nutrition Examination Survey 2009–2014, and included self-reported information on dietary and supplement intake from a single day of 24-hour recalls, serologic indicators, and dual x-ray absorptiometry images.

The team's statistical analysis included multiple linear regression modeling controlled for age, sex, race/ethnicity, energy intake, and poverty income ratio.

Rates of likely undiagnosed celiac disease were 1 in 285. Patients with likely celiac disease showed an average 251.6 mg higher daily total calcium intake, higher dairy consumption by 0.7 cups per day, and higher serum phosphorus levels. Probable celiac patients showed a substantially higher total dietary and supplement intake measured in calcium density and phosphorus density. 

The researchers saw no differences in serum calcium, vitamin D, or alkaline phosphatase levels between the groups. Patients with likely celiac disease were associated with lower femur bone mineral density (BMD) and a lower femoral neck BMD, but showed no difference in total spine BMD.

This is one of the first studies to examine variations in nutritional intake of calcium, vitamin D, and phosphorus; their levels in the blood; and bone health in adults with and without likely, undiagnosed celiac disease.

Adults with probable undiagnosed celiac disease had lower bone density than those without celiac disease, even though they reported higher calcium intake and nutritional density of calcium and phosphorus. Among other things, the variations in BMD in this study demonstrate the importance of early diagnosis and the rapid adoption of a gluten-free diet for patients with undiagnosed celiac disease.

Read more in the J Am Coll Nutr. 2019 Jul 19:1-10. 

Celiac.com 12/24/2018 - People with celiac disease, including adults with subclinical celiac disease, have low bone mineral density (BMD), deteriorated bone microarchitecture and meta-analysis show an increased risk of fracture. Immunoglobulin A (IgA) against transglutaminase 2 (IgA TG2) is a highly reliable marker to detect celiac disease.

A team of researchers recently set out to explore the prevalence of positive IgA TG2 and celiac disease in patients with distal radius and ankle fracture compared to community-based controls.

For their study case-controlled study, the researchers enrolled our hundred patients aged 40 years or above with distal fractures. The team used the National Population Registry to identify about 197 control subjects who had never suffered a fracture. The team measured BMD, and noted any comorbidities, medications, physical activity, smoking habits, body mass index (BMI) and nutritional factors. Blood analysis to detect common causes of secondary osteoporosis was performed.

They found that about 2.5% of the fracture patients had positive IgA TG2, compared to 1% in the control group. The odds ratio, adjusted for sex and age, of having positive IgA TG2 was 2.50 (95% CI 0.54–11.56).

They found that patients with fractures had no significantly greater odds of celiac disease than control subjects. However, results do indicate that positive IgA TG2 is more common in fracture patients than in control subjects. 

This study does not point to any need for universal screening for celiac disease in fracture patients, but it does support the current clinical practice in Norway of looking for celiac disease in patients with fracture, osteoporosis and other risk factors for celiac disease.

Read more at Tandfonline.com
https://doi.org/10.1080/00365521.2018.1509122   
 

The research team included Anja M. Hjelle, Ellen Apalset, Pawel Mielnik, Roy M. Nilsen, Knut E. A. Lundin & Grethe S. Tell. They are variously affiliated with the the Department of Rheumatology, Division of Medicine, District General Hospital of Førde, Førde, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; the Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; the Bergen group of Epidemiology and Biomarkers in Rheumatic Disease (BeABird), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway; the Department of Rheumatology, Division of Medicine, District General Hospital of Førde, Førde, Norway;  the Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway;  the Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway; KG Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway; and the Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

Celiac.com 08/28/2018 - There have been a number of studies that tried to estimate risk levels for celiac disease in patients with osteoporosis, but the data has been highly variable and inconclusive. To address this, a team of researchers recently set out to investigate rates of celiac disease among individuals with osteoporosis.

The research team included M. Laszkowska, S. Mahadev, J. Sundström, B. Lebwohl, P. H. R. Green, K. Michaelsson, and J. F. Ludvigsson. They are variously affiliated with the Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA, the Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University in Uppsala, Sweden, the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet in Stockholm, Sweden, the Department of Paediatrics, Örebro University Hospital in Örebro, Sweden, and with the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham in Nottingham, UK. 

The team conducted a systematic review of articles that appeared in PubMed, Medline or EMBASE through May 2017 to find studies on rates of celiac disease in patients with osteoporosis. Search terms included “coeliac disease” combined with “fractures”, “bone disease”, “bone density”, “densitometry”, “osteoporos*”, “osteomal*”, “osteodys” or “dexa” or “dxa” or “skelet”. Non‐English papers with English‐language abstracts were included. 

To confirm their data, the team used fixed‐effects inverse variance‐weighted models, and tested heterogeneity through both subgroup analysis and meta‐regression. They found a total of eight relevant studies, containing data from 3,188 people with osteoporosis. From this group, the team found 59 individuals, or just under 2%, with celiac disease.

A weighted pooled analysis showed biopsy‐confirmed celiac disease in 1.6% of osteoporosis patients. 

The team found moderate heterogeneity (I2 = 40.1%), which was influenced by the underlying celiac disease rates in the general population. After adding four studies covering a total of 814 people with celiac disease, based on positive tissue transglutaminase or endomysial antibodies, the pooled rate was comparable (1.6%; 95% CI = 1.2%‐2.0%).

About 1.6% of people with osteoporosis have biopsy‐verified celiac disease. That’s about the same rate as the general population. Based on this data, the team sees no need to routinely screen osteoporosis patients for celiac disease, contrary to current guidelines. They suggest additional studies to assess the benefits and desirability of such screening programs.

So, it looks like there’s no reason for people with osteoporosis, or their doctors, to be concerned about celiac disease unless patients shows some physical symptoms or signs.

Read more in: Alimentary Pharmacology & Therapeutics

Celiac.com 05/01/2018 - Celiac disease is marked by a variety of intestinal and extra-intestinal symptoms. One of the most common and best described expressions of celiac disease outside the gut is the presence of osteopenia and osteoporosis, which make for a higher fracture risk.

A team of researchers recently set out to see if a gluten-free diet (GFD) improves bone mineralization. The research team included MB Zanchetta, AF Costa, V Longobardi, R Mazure, F Silveira, MP Temprano, H Vázquez, C Bogado, SI Niveloni, E Smecuol, ML Moreno, A González, E Mauriño, JR Zanchetta, and JC Bai.

They are variously associated with the Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina; Research Institute, Universidad del Salvador, Buenos Aires, Argentina; the Department of Medicine, Dr C. Bonorino Udaondo Gastroenterología Hospital, Buenos Aires, Argentina; and with Consejo de Investigaciones en Salud, Health Ministry, Buenos Aires City Government, Buenos Aires, Argentina.

These researchers previously identified a significant deterioration of bone microarchitecture in premenopausal women with newly diagnosed celiac disease using high‐resolution peripheral quantitative computed tomography (HRpQCT). In that study, the team also compared 1‐year results with those of a control group of healthy premenopausal women of similar age and BMI in order to assess whether the micro-architectural parameters of treated celiac patients had reached the values expected for their age.

While that study showed that a year on a gluten-free diet had improved most of the women’s bone parameters, it also showed that those parameters continued to be significantly lower than those of healthy control subjects.

In a recent paper, the team describes the results of their study that offers data to show improvements bone mineralization microarchitecture in celiac patients after three years on a gluten-free diet.

Source:

• Clin Gastroenterol Hepatol. 2017 Oct 6. pii: S1542-3565(17)31200-4. doi: 10.1016/j.cgh.2017.09.054.

Celiac.com 06/19/2017 - Adults with celiac disease often show atypical symptoms, though it is not uncommon for them to suffer from malabsorption of vitamins and minerals, which can result in disrupt normal bone metabolism.

A team of researchers recently set out to evaluate laboratory deficiencies related to bone metabolism, and to assess the relationship between severity of histological damage and the degree of bone mass loss at celiac diagnosis. The research team included L. Posthumus, and A. Al-Toma A of the Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands.

Their team conducted a retrospective cross-sectional study of 176 adult celiac patients. All patients met the histopathological criteria for clinical celiac disease. The team analyzed biochemical data, including calcium, phosphate, alkaline-phosphatase, vitamin D and parathormone. They classified duodenal histology based on Marsh parameters. They used dual X-ray absorptiometry to determine bone mass density (BMD) at the lumbar and femoral regions. P-values below 0.05 were considered significant.

They found no correlation between gastrointestinal symptoms and Marsh histopathological stage (P>0.05). Nearly 50 percent of patients showed vitamin D deficiency (44.5%), while only 5.7% showed hypocalcaemia. Patients with Marsh III did show lower calcium (P<0.05) and parathormone was higher (P=0.01). These patients had lower lumbar T-score (P<0.05). Although low BMD occurred in all age groups, most osteoporotic patients were aged 45-49 years (81.8%).

A multiple regression analysis did show that Marsh stage could indicate lower lumbar BMD (r=0.322, B=-1.146, P<0.05).

At celiac diagnosis, Marsh histopathological stage can predict low BMD, which can develop into osteoporosis. Based on these data, the team suggests that doctors should consider evaluating bone biomarkers and conducting a dual X-ray absorptiometry exam in celiac patients over 30 years of age.

Source:

• Eur J Gastroenterol Hepatol. 2017 Apr 27. doi: 10.1097/MEG.0000000000000880.