Celiac Disease and Osteoporosis Linked
Strict Gluten-Free Diet Can Help Recover Bone Mineral Density
Oct 9, 2009
Osteoporosis and low bone density are well-documented complications for patients diagnosed with celiac disease.
It has been commonly assumed that the restricted diets that celiac patients must follow meant that they weren’t getting sufficient levels of calcium and vitamin D. Once patients have been diagnosed with celiac disease, they are carefully monitored for these vitamins and minerals, and are often put on supplementation regimens.
Likewise, those who suffer from celiac disease without a diagnosis and without following a gluten-free diet also show lower bone density. This has been believed to be due to malabsorption of those same vitamins and minerals as the villi in the small intestine are damaged by ingested gluten.
Two studies published on October 8, 2009 are showing that malabsorption and the restricted diet may not be the only connections between celiac and osteoporosis.
Celiac Autoimmune Response Damages Bones
In the first of the two reports from Science Daily, published in the New England Journal of Medicine from researchers at the University of Edinburgh, there is an undoubted link between celiac disease and osteoporosis in an unexpected way.
The study followed celiac patients and their bodies’ responses to a protein called osteoprotegerin. This protein, also called OPG, plays a vital role in bone health. Just like skin, organs and other parts of the body, bones have to slough off old cells and generate new ones. OPG limits the number of bone cells removed at a given time. So when there’s not enough OPG present, there is “rapid bone destruction and severe osteoporosis.”
The study found that antibodies in celiac patients actually attack the OPG protein. “It is the first time an autoimmune response – a condition whereby the body can attack itself – has been shown to cause damage to bones directly.”
Particularly disturbing about this development is that this form of osteoporosis cannot be managed with calcium and vitamin D supplementation. The disease did respond well to drugs that prevent bone tissue loss, though those drugs are not approved for pre-menopausal women.
What is not clear, however, is whether this autoimmune response continues, even if the celiac patient follows a gluten-free diet. One would hope that patients could mitigate this risk by restoring proper digestion and gut health and by cutting back on the autoimmune response throughout the body. In fact, the second report released by Science Daily attempts to prove just that.
Gluten-Free Diet Can Lead to Complete Recovery in Celiac Cases Diagnosed Before Puberty
The article appeared in the journal Nutrition Reviews from researchers at the School of Public Health at São Paulo University in Brazil. Similar to the University of Edinburgh’s study, these researchers were delving deeper into the known complication of bone density among celiac patients.
However, these physicians discovered significant increases in bone health in those patients following a gluten-free diet, particularly children diagnosed with celiac early in life.
In the abstract for the article, these researchers explain that a gluten-free diet actually results in a rapid increase in bone mineral density “that leads to complete recovery of bone mineralization in children. 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, nutritional supplements consisting of calcium and vitamin D seem to increase the bone mineral density of children and adolescents with celiac disease.
As for adults? If the celiac is discovered after puberty the gluten-free diet “improves, but 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."
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