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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 Watch the video version of this article:

Celiac.com 04/10/2021 - It was gratifying to learn, from a recent post to the Celiac Listserv, that some celiac-savvy medical practitioners are now ordering bone density testing as soon as a patient’s serology indicates celiac disease. This emerging standard of care is well rooted in the medical and scientific literature and constitutes a reasonable and appropriate strategy for the effective care and treatment of celiac disease patients. Investigators have been recommending this approach for more than a decade(1,2) and these recommendations are particularly important given the more recent data that showing a dramatic fracture rate among celiac patients that is seven times that of controls(3,4). Although the sensitivity of endomysium (EMA) and tissue transglutaminase (tTG) may be open to criticism, there can be little doubt that these tests are quite specific and usually reported as close to 100%. Simply put, almost everyone who has positive serological test results will be shown to have celiac disease. Thus, when an EMA or tTG test is positive for celiac disease it is very likely that the individual in question has, or soon will have, celiac disease. Although a controversial approach, some practitioners are even diagnosing celiac disease based on serology alone. Researchers have long known that celiac disease is associated with significant bone demineralization and increased risk of fractures(5). Relevant research also shows that therapeutic intervention in celiac patients can require a very different approach than with non-celiac patients(6-7) and there is considerable variation from one celiac patient to the next(1) which practitioners must also consider. Suspected causes of the increased bone disease and fracture risk include: reduced intestinal absorption area and compromised active transport of calcium across the intestinal barrier3; hyperparathyroidism, possibly as the result of cross reaction of endomysium antibodies with parathyroid tissues(8); autoimmune hyperthyroid disease, which is frequently found in association with celiac disease(9); excessive mineral release from the bones and excretion(3); vitamin D deficiency(10); along with a host of other celiac-associated possibilities. Each or many of the above factors are likely contributors to the unique needs of every newly diagnosed celiac patient. Even when bone density testing reveals metabolic bone disease, it does not reveal the exact nature of the underlying problem(3) and celiac disease patients with bone mineral losses often can not be predicted clinically(1) so testing is the only rational option. While a strict gluten-free diet will usually have a positive impact on bone density, that improvement falls far short of control values(11). Bone density values and trends will provide assistance in determining individual fracture risk, which is an important clinical consideration(2). Every person, regardless of their celiac disease diagnosis, is unique. It is especially important that each one should have early testing to determine their bone mineral status at diagnosis because of the very strong association between celiac disease and bone disease. Such test results enable health care providers to monitor their celiac patients’ bone health and fracture risk. Simply put, if we can not see where we started from, how can we tell how far we have come or whether we are moving in the right direction? Early bone density testing is the first step in therapeutic intervention. In many cases, coupled with follow-up testing, it will be the only intervention needed. In other cases, however, bone density testing will be the first step in a lengthy therapeutic process that may involve several changes in treatment as the individual progresses. Some patients may require magnesium supplementation as part of a therapeutic intervention for parathyroid disease(6). Others may need treatment for autoimmune thyroid disease which afflicts more than 12.9% of newly diagnosed celiac patients(12). Most celiac patients have been shown to have low vitamin D status(10) which, depending on a variety of factors, may indicate a need for vitamin D supplementation. Still others may require pharmacological interventions. Alert practitioners will, in keeping with the literature, order bone density testing. Abnormal results should identify concurrent bone disease and alert the practitioner to the need for further testing to determine the exact nature of the pathology/pathologies that may be at work. Regardless of the particular cause of bone disease or abnormality, bone density testing is the very first step in each of these interventions. Follow-up bone density testing will usually provide meaningful information to direct treatment and is especially useful when juxtaposed with initial test results. There can be little doubt that bone density testing is appropriate for newly diagnosed celiac disease patients. This practice is strongly advocated in the medical and scientific literature, and promises to mitigate the sometimes ghastly consequences of bone disease, demineralization, and degeneration that are too often found in association with celiac disease. Ultimately, such testing will not only improve quality of life for celiac patients, but in combination with appropriate supplementation, dietary, and pharmacological practices, this testing will save health care dollars through reduced needs for acute care. For these reasons, I was surprised to read that the insurance company of the person who posted that message to the celiac listserv had refused to pay for the bone density testing ordered by her health care practitioner on the basis of positive celiac serology. In the early days of endomysium and tissue transglutaminase testing, some insurance companies also failed to see that serological testing would one day save substantial sums by reducing the number of endoscopic biopsies required for a celiac diagnosis. My own diagnosis required three endoscopic biopsies. Similarly, it appears that at least one insurance company is overlooking the savings from acute care that they will accrue from the emerging standard of care in which bone density testing is ordered for all patients with positive celiac serology tests. One can only hope that they will soon recognize the real cash value such testing offers to health insurance providers. References: 1. Walters JR, Banks LM, Butcher GP, Fowler CR. Detection of low bone mineral density by dual energy x ray absorptiometry in unsuspected suboptimally treated celiac disease. Gut. 1995 Aug;37(2):220-4. 2. Pistorius LR, Sweidan WH, Purdie DW, Steel SA, Howey S, Bennett JR, Sutton DR. Coeliac disease and bone mineral density in adult female patients. Gut. 1995 Nov;37(5):639-42. 3. Fickling WE, McFarlane XA, Bhalla AK, Robertson DAF. The clinical impact of metabolic bone disease in coeliac disease. Postgrad Med J. 2001; 77:33-36 4. Vitoria JC, Arrieta A, Arranz C, Ayesta A, Sojo A, Maruri N, Garcia-Masdevall MD. Antibodies to gliadin, endomysium, and tissue transglutaminase for the diagnosis of celiac disease. J Pediatr Gastroenterol Nutr. 1999 Nov;29(5):571-4. 5. Marsh MN. Bone disease and gluten sensitivity: time to act, to treat, and to prevent. Am J Gastroenterol. 1994 Dec;89(12):2105-7. 6. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int. 1996;6(6):453-61. 7. Hoggan R. 8. Kumar V, Valeski JE, Wortsman J. Celiac disease and hypoparathyroidism: cross-reaction of endomysial antibodies with parathyroid tissue. Clin Diagn Lab Immunol. 1996 Mar;3(2):143-6. 9. Kisakol G, Kaya A, Gonen S, Tunc R. Bone and Calcium Metabolism in Subclinical Autoimmune Hyperthyroidism and Hypothyroidism. Endocrine Journal Vol. 50 (2003) , No. 6 657-661 10. .Kemppainen T, Kröger H, Janatuinen E, Arnala I, Kosma VM, Pikkarainen P, Julkunen R, Jurvelin J, Alhava E, Uusitupa M. Osteoporosis in adult patients with celiac disease. Bone. 1999 Mar;24(3):249-55. 11. McFarlane XA, Bhalla AK, Robertson DA.Effect of a gluten free diet on osteopenia in adults with newly diagnosed coeliac disease. Gut. 1996 Aug;39(2):180-4. 12. Sategna-Guidetti C, Volta U, Ciacci C, Usai P, Carlino A, De Franceschi L, Camera A, Pelli A, Brossa C. Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study. Am J Gastroenterol. 2001 Mar;96(3):751-7.

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 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.