People with coeliac disease suffer an autoimmune reaction when they eat gluten. The immune system attacks gluten as if it were a toxin and, in the process, cause damage to the lining of the intestine, which tends to lead to problems absorbing food.
Osteoporosis, whose main cause is a lack of calcium in the diet, is often found in coeliac patients. The sooner a person is diagnosed with coeliac disease and switches to a gluten free diet, the better their chances of avoiding osteoporosis.
Osteoporosis is a complication of untreated coeliac disease, due to the reduced ability of the small intestine in coeliac patients to absorb important nutrients, notably calcium in this case.
Some studies have shown that low BMD can affect up to 75% of people when they are diagnosed with coeliac disease. Even people who otherwise have few symptoms of coeliac disease can have a much lower BMD than the average for the general population.
Most people are diagnosed with coeliac disease later in life in their 50s, 60s or 70s, well after the age at which we reach peak bone mass, which is in our mid-20s. According to research cited by the organisation Coeliac UK, the average time between the onset of symptoms and a coeliac disease diagnosis is 13 years, during which time the body will not be able to absorb important vitamins and mineral such as calcium and vitamin D in sufficient quantities, leading to weaker bones.
On the other hand, a person who is diagnosed with coeliac disease during their childhood or adolescence is unlikely to experience any long-term impact on their bone health as long as they adopt a strict gluten free diet. Most coeliac patients should find that their BMD will improve after starting a gluten free diet, but it can be more difficult for women diagnosed after the menopause to build up bone strength.
Coeliac patients are also at special risk of developing osteoporosis as they tend to have a smaller build and because of the increased likelihood of having thyroid disease, which may also play a role in osteoporosis. If you have been diagnosed with coeliac disease, you should discuss with your doctor or specialist whether it is also the time to be tested for osteoporosis.
People with coeliac disease who have switched to a gluten free diet have taken an important step towards avoiding, or at least mitigating, osteoporosis, but it is still important to take further action to strengthen bones. The most basic strategies include ensuring you get enough calcium and vitamin D, doing weight-bearing exercise, not smoking and avoiding excessive alcohol use.
Good sources of calcium include dairy products, dark green leafy vegetables, and calcium-fortified foods and drinks. Adults with coeliac disease should have at least 1,000mg of calcium every day. Vitamin D is found in plentiful quantities in egg yolks, saltwater fish and liver. Everyone should have 4 micrograms of vitamin D a day, and consider taking supplements in the winter months if they are not getting much sun.
An older person with coeliac disease may be advised to take supplements to ensure they are getting enough of these two nutrients.
As well as paying close attention to diet and ensuring that the right amount of nutrients for bone growth are being taken, a person with osteoporosis should try to maintain a healthy and fit body through exercise and sensible lifestyle choices.
Exercise such as walking or running where the body has to work against gravity is good for strengthening bones, as is working out with weights. All kinds of exercise tone muscles, which is also important to maintain flexibility and joint mobility, helping to avoid falls and subsequent fractures.
Smoking is bad for bones, as well as for the heart and lungs. Women who smoke tend to reach menopause sooner, resulting in an earlier reduction in levels of the bone-preserving hormone oestrogen and triggering earlier bone density loss. Smoking may also affect calcium absorption, and drinking in excess is also considered to be a potentially aggravating factor for osteoporosis.
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