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Celiac Disease and Bone Health

Celiac disease is a condition that affects the gastrointestinal tract, but surprisingly, one of its most concerning complications is how it affects the bones. Nearly 75 percent of newly-diagnosed patients with celiac disease already have osteoporosis or osteopenia, and among celiac patients with mild or no symptoms who decide to get tested because of their family history, approximately half of them experience bone loss. Over time, this bone loss can contribute to an increased risk of fractures.

There are several ways that celiac disease can contribute to bone loss:

Malnourishment
Celiac disease is an autoimmune disorder characterized by an allergy to gluten, a protein composite found in wheat, rye and barley. When someone with celiac disease consumes gluten, the body triggers an immune response that harms the villi of the small intestine. When the villi become damaged, they are unable to properly absorb nutrients. Even if a celiac patient consumes adequate amounts of bone-building nutrients such as vitamin D, vitamin K, calcium, magnesium and potassium, the nutrients may not be absorbed in adequate amounts, causing the bones to become weak.

Secondary hyperparathyroidism
Some celiac patients have secondary hyperparathyroidism, a condition in which low blood calcium levels cause the parathyroid glands produce too much parathyroid hormone (PTH). This hormone causes the bones to release calcium in order to normalize blood calcium levels, ultimately resulting in bone loss.

Autoimmunity
Tissue transglutaminase (tTG) is an enzyme that plays an important role in bone remodeling, but when someone with celiac disease consumes gluten, their gut produces antibodies that attack tTG. Celiac patients may also produce antibodies that attack osteoprotegerin, a protein produced by osteoblasts that prevents bone from breaking down.

Immune response
In celiac patients, gluten can trigger the immune cells to produce cytokines. These chemical messengers promote the production of osteoclasts, the bone cells that break down and resorb bone tissue.

Peter H.R. Green, M.D., director of the Celiac Disease Center at NewYork-Presbyterian Hospital/Columbia University Medical Center, recommends following a strict gluten-free diet as the first step in preventing bone loss in celiac patients. Eliminating gluten will allow the gut to heal and reduce the risk of fractures. Look for gluten-free foods that are rich in bone-building nutrients, such as calcium, magnesium, vitamin D, vitamin K and B vitamins.

In addition to diet modification, patients should maintain regular doctor visits to identify other causes of bone loss, such as hormonal imbalances or hyperparathyroidism. Routine testing may be necessary to evaluate bone health and determine whether medications or supplements are needed (Source: Today's Dietician).