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Osteoporosis Linked to Celiac Disease

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TUESDAY, March 1 (HealthDay News) -- People with osteoporosis, the bone-weakening condition, may also have celiac disease and should be screened for that illness, too, a new study recommends.

A review of 266 people being treated for osteoporosis found that nine of them had celiac disease, an intestinal disorder caused by intolerance to gluten found in wheat, rye and other grains. Just one of 574 people without the bone disease also suffered from celiac disease, the study found.

"Our results suggest that as many as 3 to 4 percent of patients who have osteoporosis have the bone condition as a consequence of having celiac disease," said Dr. William F. Stenson, a professor of medicine at Washington University School of Medicine in St. Louis, who led the study.

The finding appears in the Feb. 28 issue of the Archives of Internal Medicine.

Celiac disease causes an immune reaction to gluten that interferes with the ability of the intestine to absorb nutrients, including the calcium and vitamin D that are essential to the health of bones. A gluten-free diet improved bone density as well as gastrointestinal symptoms for people with celiac disease, the researchers reported.

"We believe that the diet allowed the intestines to heal and that permitted normal absorption of calcium and vitamin D to reverse bone loss," Stenson said.

While a severe case of celiac disease produces obvious symptoms such as weight loss and diarrhea, mild cases often go undiagnosed because they cause more subtle problems, such as iron deficiency anemia, the researchers said.

"One of our conclusions is that incidence of celiac disease in patients with osteoporosis is high enough to justify screening for everybody with osteoporosis," Stenson said. "The idea is that if a patient has osteoporosis as a consequence of celiac disease, the most direct way to correct their bone loss would be to put them on a gluten-free diet."

The Washington University report ties in with a Finnish study, released last year, which found that one in every 99 children tested in a pilot study had undetected celiac disease, and a study done two years ago at the University of Maryland that found an incidence of one in 133 children. But both the Finnish and Maryland researchers said the case for mass screening was still unproven.

"Screening is not something I would recommend for any group based on the Stenson [Washington University] study, viewed with other data," said Dr. Alan L. Buchman, associate professor of medicine at the Northwestern University Feinberg School of Medicine, who wrote an accompanying editorial in the journal. "But it is an issue we can't ignore."

Costs linked to a generalized screening is one important consideration, he said. "The cost to prevent a single fracture in a patient with celiac disease and osteoporosis would be $43,000," Buchman wrote.

"What probably needs to be done is a study that has a large number of subjects, a cross-section across the nation to determine the incidence," Buchman said. Such a study "would take a long time to do and cost a lot of money," he added, but "if we screened everybody that would cost billions of dollars."

More information

The National Institute of Diabetes and Digestive and Kidney Diseases offers an overview of celiac disease.

SOURCES: William F. Stenson, M.D., professor of medicine, Washington University School of Medicine, St. Louis: Alan L. Buchman, M.D., associate professor of medicine, Northwestern University Feinberg School of Medicine, Chicago; Feb. 28, 2005 Archives of Internal Medicine
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