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Celiac.com 04/09/2012 - Many people with celiac disease suffer from fatigue and may limit theirsocial activities, both of which can lead to a decrease in physicalactivity, and potentially lower bone mass. A team of medical researchers recently set out to study the effects of exercise and gluten-free diet on bone-mass in women with celiac disease. The research team included Valentina Passanantia, Antonella Santonicolaa, Cristina Buccia, Paolo Andreozzia, Antonella Ranaudoa, Daniel V. Di Giacomoc, and Carolina Ciacci. They are affiliated with the Department of Clinical and Experimental Medicine at the University Federico II of Naples, Italy, the Gastrointestinal Unit of Salerno University Medical School in Salerno, Italy, and the Celiac Disease Center of the Department of Medicine at Columbia University in New York. For their study, the team recruited two groups of women. In both groups, they examined physical activity, fatigue and bone mineral density in women with celiac disease, both at diagnosis and while following a gluten-free diet. In the first group of 48 women, the team measured bone mineral density at diagnosis and after 2 years of a gluten-free diet. In the second group, this one with 47 women, researchers measured bone mineral density at diagnosis, and after 5 years of a gluten-free diet. The researchers questioned and assessed both groups regarding physical activity and ranked them on a visual analogue scale regarding their perception of fatigue at diagnosis and follow-up. The team also gathered data on smoking habits, alcohol use, gastrointestinal symptoms, drug therapy and body mass index. Across the board, for all factors, the two groups showed similar results. At follow-up, the mean body mass index and physical activity questionnaire scores were similar to baseline. Both groups showed increased bone density and unchanged scores for physical activity and visual analogue scale. For both groups, bone density improved significantly after two years on a gluten-free diet. In both groups, physical activity was often low and played only a small role in changes to bone mineral density. So, exercise does not seem to help increase bone mineral density in any significant way, and following a gluten-free diet is sufficient to re-establish bone mineral density to healthy levels. Source: 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. doi:10.1016/j.dld.2011.12.012

Celiac.com 12/15/2014 - Non-celiac gluten sensitivity (NCGS), aka `wheat sensitivity’ (NCWS), is currently included in the spectrum of gluten-related disorders. Many people with celiac disease suffer from low bone mass density, but there has been no good data on low bone mass density in people with NCWS. A team of researchers recently set out to determine rates of low bone mass density in NCWS patients and to search for correlations with other clinical characteristics. The researchers included Antonio Carroccio, Maurizio Soresi, Alberto D'Alcamo, Carmelo Sciumè, Giuseppe Iacono, Girolamo Geraci, Ignazio Brusca, Aurelio Seidita, Floriana Adragna, Miriam Carta and Pasquale Mansueto. For their prospective observation study, the team assessed 75 NCWS patients (63 women; median age 36 years) with irritable bowel syndrome (IBS)-like symptoms, along with control groups of 65 patients with IBS and 50 with celiac disease. The team recruited patients from two Internal Medicine Departments. The diagnoses of NCWS were established using an elimination diet and double-blind placebo controlled wheat challenge. The team determined bone mass density in all subjects using Dual Energy X-Ray Absorptiometry (DXA), in addition to assessing all subjects for duodenal histology, HLA DQ typing, body mass index, and daily calcium intake. The double-blind placebo controlled wheat challenge revealed that 30 of the 75 NCWS patients suffered sensitivity to multiple foods. Osteopenia and osteoporosis frequency increased from IBS to NCWS and to celiac disease (P <0.0001). Thirty-five of the patients with NCWS (46.6%) showed osteopenia or osteoporosis. Low bone mass density was related to low body mass index and multiple food sensitivity. Levels of daily dietary calcium intake were significantly lower in NCWS patients than in control subjects with IBS. The study showed that patients with NCWS suffered from higher rates of bone mass loss; which correlated with low body mass index, and was more frequent in NCWS patients who showed sensitivity to multiple foods. The team also found that patients with NCWS generally had a low daily intake of dietary calcium. Source: BMC Medicine 2014, 12:230. doi:10.1186/s12916-014-0230-2

Celiac.com 11/11/2013 - Celiac disease affects about 1-2% of people, globally. Formerly regarded as a childhood disease, most people are now diagnosed with celiac disease as adults. Many of those adults with celiac disease suffer the consequences of an impaired bone mineralization. Researchers A.J. Lucendo, and A. García-Manzanares recently sought to provide new data on the relationship between low bone mineral density (BMD), osteopenia and osteoporosis, and celiac disease. To do so, they conducted a PubMed search of last 15 years, and reviewed sources cited in the results to find potential sources of information. They found that up to 75% of celiac patients show the effects of low bone mineral density. These effects can be seen can at any age, and they can be seen even with no positive serological markers an no digestive symptoms. Rates of celiac disease are also much higher among osteoporotic patients. Additionally, 40% of those diagnosed with celiac disease as adults show the effects of low bone mineral density. The researchers offer two possible theories to explain the causes of low bone mineral density in celiac patients. In the first theory, they note that malabsorption of micronutrients, including calcium and vitamin D, caused by villous atrophy has been related to secondary hyperparathyroidism and inability to reach normal bone mass levels. They also note that chronic inflammation is also related with RANKL secretion, osteoclasts activation and increased bone resorption. Whatever the cause, as a consequence, celiac patients have more than a 40% greater risk for bone fractures than their healthy counterparts. This study shows that up to 75% of celiac patients and 40% of celiacs diagnosed as adults have low BMD, and a variable increase in the risk of bone fractures. Such realities mean that bone density scans more important for adults with celiac disease. Source: Rev Esp Enferm Dig. 2013 May;105(3):154-162.

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.

Celiac.com 11/07/2011 - Fat-soluble vitamin malabsorption, inflammation and/or under-nutrition put children with celiac disease at risk for decreased bone mineral density. A research team recently set out to determine how vitamin D and K might influence bone mineral density and bone growth in children and adolescents with celiac disease. The study team included D. R. Mager, J. Qiao, and J. Turner. The team's goal was to examine the interrelationships between vitamin K/D levels and lifestyle factors on bone mass density in children and adolescents with celiac disease at diagnosis and after 1 year on the gluten-free diet. The team studied children and adolescents aged 3–17 years with biopsy proven celiac disease at diagnosis and after 1 year on the gluten-free diet. To measure bone mineral density the researchers used dual-energy X-ray absorptiometry, factoring in relevant variables including anthropometrics, vitamin D/K status, diet, physical activity and sun exposure. The children saw their lowest BMD-z scores for whole-body and lumbar-spine (−1) at diagnosis (10–20%) and after 1 year (30–32%), independent of symptoms. Older children (>10 years) showed substantially lower BMD-z scores for whole-body (−0.55±0.7 versus 0.72±1.5) and serum levels of 25(OH) vitamin D (90.3±24.8 versus 70.5±19.8 nmol/l) as compared with younger children (10 years) (P<0.001). Overall, forty-three percent showed suboptimal vitamin D status (25(OH)-vitamin D <75 nmol/l) at diagnosis. Nearly half of these vitamin D deficiencies corrected after 1 year on the gluten-free diet. Also, twenty-five percent of the children showed suboptimal vitamin K status at diagnosis. All vitamin K deficiencies resolved after 1 year. Both children and adolescents with celiac disease face a substantial risk for suboptimal bone health at time of diagnosis and up to 1 year after adopting a gluten-free diet. This higher risk is likely due in part to suboptimal vitamin D/K levels. Children and teens with celiac disease may benefit from treatment regimens that promote optimal vitamin K/D intake. Source: European Journal of Clinical Nutrition, (5 October 2011) | doi:10.1038/ejcn.2011.176

Celiac.com 07/12/2012 - A research team affiliated with the Department of Endocrinology and Nutrition at Complejo Hospitalario Mancha Centro in Alcázar de San Juan, Spain, recently set out to study how bone mineral density correlates with duodenal Marsh stage in newly diagnosed adult celiac patients. The team made up of A. García-Manzanares, J.M. Tenias, and A.J. Lucendo. For their study, the researchers wanted to estimate the rates of low bone mineral density (BMD) in adult celiac patients and to better understand nutritional and metabolic factors associated with osteoporosis and osteopenia. To do so, they recruited patients a consecutive group of 40 adults (36 females/4 males), between the ages of 18 and 68, who were newly diagnosed with celiac disease. Average patient age was 44.25 years. For each patient, the researchers conducted bone density scans on the left hip and lumbar spine using dual-energy X-ray absorptiometry. They also assessed nutritional parameters and conducted a hormone study to exclude secondary low BMD. Overall, at diagnosis 45% of patients showed low BMD at both hip and lumbar spine. Risk of hip fracture was generally low, but climbed into the mild range for patients with villous atrophy (p = 0.011). The team also found that major fracture risk varied according to Marsh stage (p = 0.015). They found significant differences in nutritional status between patients with and without duodenal villous atrophy. Marsh III stage patients showed substantially reduced body mass index and blood levels of pre-albumin, iron, vitamin D and folic acid. The team found no differences found in blood hormone levels between Marsh stages or BMDs. They found that the amount of bone mass loss in the lumbar spine was directly tied to Marsh stage. They found a parallel association between BMD and Marsh stage in the hip, but this was not statistically significant. Overall, results showed that duodenal villous atrophy, through malabsorption, was the main factor for low BMD in patients with adult-onset celiac disease. Source: Scand J Gastroenterol. 2012 May 16.

The following was received on March 5, 1998 from Kathryn K. Harden, Ph.D., k-harden@UIUC.EDU, Assistant Editor, The Journal of Nutrition, University of Illinois, Urbana-Champaign. The latest issue of the American Journal of Clinical Nutrition contains two articles concerning celiac disease. It is encouraging to see research papers concerning celiac disease in important basic research and clinical journals. The citations are: Reversal of low bone density with a gluten-free diet in children and adolescents with celiac disease. S. Mora, G. Barera, A. Ricotti, G. Weber, C. Bianchi and G. Chiumello. AJCN 67: 477-481, 1998. The authors conclude that in children and adolescents with low bone mineral density (BMD) due to celiac disease, a gluten free diet promotes a rapid increase of BMD that leads to a complete recovery of bone mineralization. Due to the severe consequences of low BMD, the authors emphasize the need for early diagnosis and treatment of celiac disease. Nutritional status of newly diagnosed celiac disease patients before and after the institution of a celiac disease diet - association with the grade of mucosal villous atrophy. T Kemppainen, V-M Kosma, E Janatuinen, R Julkunen, P Pikkarainen, M Uusitupa. AJCN 67: 482-487, 1998. Authors found that celiac disease patients with 3 levels of intestinal villous atrophy (partial, subtotal, total) did not differ in the nutritional status variables measured except erythrocyte folate and serum ferritin concentrations. The following was received from J.C. Trevett JCTrevett@aol.com on September 28, 1998: Two articles I would like to add to your list if you dont already have info. Journal of Pediatrics, August 1998 article entitled, Celiac disease: A Reappraisal, by David Branski, MD and Ricardo Troncone, MD. Dr. Branski is Dept. of Pediatrics, Shaare Zedek Medical Center, P. O. Box 3235, Jerusalem, Israel. It is a good five page article referring to the tip of the iceberg again - at least all the experts are in agreement all over the world that we are not diagnosing enough celiac disease. This is a good article - there is some technical stuff about the DB MOLECULE, which I will never understand, but I gave a copy to my gastroenterologist and he seemed to appreciate it. Tufts University, Medford, MA, Tufts Health & Nutrition Letter - September, 1998 - Volume 16, Number 7. Good article for average layperson on Coping with Celiac Disease - mentions CSA/USA, Inc. and its many (80) support groups throughout the country. Also mentions Gluten Intolerance Group, Energy Foods and Dietary Specialties. To quote part of the article: In one survey, 43 percent of those with the condition said that theyd been diagnosed with an assortment of ailments - such as anemia, stress, ulcers, and nerves before finding out that celiac disease was responsible for the symptoms.