From the Guidelines
Patients with celiac disease are at greatest risk for osteoporosis and fractures later in life, with an estimated incidence of fracture being 40% by age 70, which is more than twice the expected incidence for the general population. This increased risk is due to malabsorption of nutrients, particularly calcium and vitamin D, which are essential for bone health 1. The prevalence of osteoporosis in patients with celiac disease is approximately 28% at the spine and 15% at the hip, and even those on a gluten-free diet have a higher prevalence of osteoporosis compared to controls 1.
Some key factors that contribute to the increased risk of osteoporosis in patients with celiac disease include:
- Low bone mass density (BMD) at diagnosis, which can be improved with a gluten-free diet but may not fully recover to average levels 1
- Increased parathyroid hormone (PTH) levels and diminished 25-OHD levels, which can indicate poor bone health 1
- Equal risk for osteoporosis in males and females, with postmenopausal females being at greatest risk 1
- Asymptomatic celiac disease, which can still lead to increased risk of osteoporosis 1
To mitigate these risks, it is essential for patients with celiac disease to adhere to a strict, lifelong gluten-free diet and undergo regular monitoring of their nutritional status and bone health, including periodic blood tests and bone density scans 1.
From the Research
Complications of Celiac Disease
Patients with celiac disease (CD) are at risk for several complications later in life, including:
- Malignancy and mortality, with increased risk in patients who do not comply with a gluten-free diet 2
- Osteoporosis and fragility fractures, particularly of the distal radius, due to bone loss and deteriorated bone microarchitecture 3
- Autoimmune disorders, such as autoimmune thyroid disease, type 1 diabetes mellitus, and inflammatory bowel disease, which have an increased prevalence in patients with CD 2, 4, 5
- Anemia, which can be prevented with a gluten-free diet 2, 4, 5
- Infertility, which can be improved with a gluten-free diet 4
- Osteomalacia, which can occur due to malabsorption of calcium and vitamin D 6
- Hyperparathyroidism, which can accelerate bone loss 6
Risk Factors for Complications
Certain factors can increase the risk of complications in patients with CD, including:
- Poor compliance with a gluten-free diet, which can increase the risk of malignancy and mortality 2
- Older age, menopausal status, previous fracture history, and familial hip fracture history, which can increase the risk of osteoporosis and fragility fractures 3
- Presence of autoimmune disorders, such as type 1 diabetes mellitus or autoimmune thyroid disease, which can increase the risk of CD and other complications 2, 4, 5
Screening and Diagnosis
Screening for CD is recommended in high-risk patients, such as those with autoimmune diseases, and can be done using serological tests, such as tissue transglutaminase immunoglobulin antibody and endomysial immunoglobulin antibody 2, 5. Intestinal biopsy is the gold standard for diagnosis, but can be pursued even if serologic tests are negative if suspicion of CD is high 5.