Celiac Disease and Bone Health

By Marsha McCulloch, MS, RD, LD | Today’s Dietitian

Protecting the bones should take precedence in medical nutrition therapy for patients.

Celiac Disease and Bone HealthTo say that reduced bone density is common in patients with celiac disease is an understatement. In fact, sometimes bone loss is how celiac disease presents to doctors. “About 10% of the people seen in our Celiac Disease Center were diagnosed with celiac disease because of reduced bone density,” says Peter H.R. Green, MD, director of the Celiac Disease Center at NewYork-Presbyterian Hospital/Columbia University Medical Center and coauthor of Celiac Disease: A Hidden Epidemic.

More than 75% of adults with untreated celiac disease and overt malabsorption at the time of diagnosis have bone loss (osteopenia or osteoporosis).1 Bone loss also affects about one-half of patients with subclinical celiac disease (who show minimal, transient celiac disease symptoms) and asymptomatic patients diagnosed with the condition as a result of testing that was prompted by a first-degree relative’s diagnosis.1 However, only in rare cases is osteomalacia, a vitamin D deficiency disease that’s characterized by bone deformities and bone pain in addition to low bone mineral density, part of the initial presentation of celiac disease.2-4

Over time, loss of bone mass translates to increased risk of broken bones.5 A systematic research review published in January in The Journal of Clinical Endocrinology & Metabolism found that celiac disease was associated with a 30% increased risk of any fracture and a 69% increased risk of hip fracture.6 Providing effective, individualized medical nutrition therapy to prevent osteoporosis, and its precursor, osteopenia, to help reduce fracture risk in celiac disease patients requires understanding the ways in which the disease can impact bones.

Connection to Bone Disease

There are several reasons for the elevated risk of reduced bone density in celiac disease, Green says. He lists these factors as: malabsorption of nutrients, such as calcium and vitamin D; secondary hyperparathyroidism; autoimmune factors, including tissue transglutaminase (tTG) antibodies, which possibly impact bone remodeling; and inflammation, including increased circulating cytokines (chemical messengers) that interfere with bone formation.

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Related Online Continuing Education Course:

Celiac Disease: Basics & Beyond

2-Hour Online CEU Course

Celiac Disease: Basics & Beyond is a 2-hour online CE/CEU course that explains the basics of celiac disease from the prevalence and pathophysiology of celiac disease to the diagnosis and management of celiac disease. It also goes beyond the basics by including the dietary treatment of celiac disease from a registered dietitian’s perspective by outlining the steps of the nutrition care process from assessment to monitoring and evaluation. Two case studies are included to assist the health professional in understanding the patient’s perspective from pre-diagnosis to disease management. This course will be informative for anyone with celiac disease as well as registered dietitians and other health professionals who work with patients with celiac disease. Course #20-76 | 2013 | 26 pages | 17 posttest questions

Professional Development Resources is a CPE Accredited Provider with the Commission on Dietetic Registration (CDR #PR001). CPE accreditation does not constitute endorsement by CDR of provider programs or materials. Professional Development Resources is also a provider with the Florida Council of Dietetics and Nutrition (#50-1635). Suggested Learning Needs: 3000, 5000, 5110, 5120, 6000

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