Celiac Support Association

Osteoporosis and Malabsorption

Lifeline, Summer 1996, Vol XIV, No 3, pp 1-2

Osteoporosis commonly means bones that have thinned from the inside due to mineral loss and have now become vulnerable to fracture. The bad news: celiacs need to see osteoporosis as a common disorder which may accompany the malabsorption syndrome. The good news, however, is that there are now several medications which can greatly assist in giving bones a boost.

What causes osteoporosis? A diet lacking in essential nutrients--especially not taking in enough calcium, a hormone imbalance (common following menopause in women) and lack of regular weight-bearing exercise all contribute to osteoporosis. It is thought that malabsorption in childhood and early adult life leads to failure of bones to reach peak strength, which normally occurs at the age of 20 to 25 years. Bone density tends to fall off slowly thereafter and although bone loss is no more rapid in patients with treated celiac disease, it is starting from a lower point.

Other causes: endocrine disorders for the celiac patient such as diabetes, thyroid overactivity, excessive adrenal or parathyroid hormones, nutritional disorders such as anorexia nervosa, and smoking. For some few individuals, there may be a mild persistent and continuing malabsorption of calcium which may not be reversible.

Common symptoms: pain in the back; height loss such as fracture in the back which can reduce height by up to three-fourths inch; the "dowager's hump," a forward bending of the spine; extreme, unyielding fatigue, although fatigue may be mimicked by other celiac-related problems; and fractures mentioned above.

Do men get osteoporosis? Yes, but less often than women; 35% of women in the U.S. and 10% of men age 60 and over have osteoporosis. Men have more bone mass and don't go through the more drastic hormone upheavals of menopause.

What are the protection factors against or to improve osteoporosis in celiac patients? Research has shown that treatment with the gluten-free diet dramatically improves bone mineral density in newly-diagnosed celiacs. Patients should stop smoking and exercise regularly. Fast walking, aerobics, jogging or more vigorous sports are exercise suggestions which protect against osteoporosis (swimming is not as good as no impact is involved).

In post-menopausal women, hormone replacement therapy may be recommended to help prevent accelerated bone loss that occurs after the menopause. A new osteoporosis drug can do something estrogen cannot, that is, to strengthen bones instead of simply slowing bone loss.

The drug alendronate, marketed under the trade name Fosamax represents a big step forward in the researcher's journey toward a cure, says Dr. Robert Recker of Creighton University, Omaha. But he expects even bigger steps in the next few years.

Two large studies published in the past year, including one headed by Dr. Recker, have indicated that alendronate can cut in half the risk of broken bones in women past menopause. More powerful drugs are being tested – drugs that can strengthen brittle bones enough to take patients out of the danger zone for fractures. Alendronate has only modest ability to make bones denser, the studies indicated. However, compared to what has been available in the past, it represents a giant step forward and is a good alternative to the hormones which some people prefer not to take.

Since thyroid and adrenal-related problems appear to be common in patients with celiac disease, evaluation and potential treatment for these conditions need to be worked out and monitored with a physician.

CSA Library Series

CSA Library Series is a collection of articles that pertain to celiac disease and dermatitis herpetiformis. Most of these articles have appeared in CSA’s quarterly newsletter, Lifeline, which all CSA members receive. Historic articles included in these resources may or may not include updated notes. Updated information indicated in red type. Articles represent the work of the author.

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