Strategy to manage Celiac Disease and Osteoporosis

By  ,  National Institute of Health
Jan 10, 2013

When people with celiac disease eliminate foods containing gluten from their diet, normal absorption of nutrients from the intestines is usually restored within a few months, although it may take up to 2 years in older adults. Eventually, most children and adults have significant improvements in bone density.

People with celiac disease who have successfully adopted a gluten-free diet also need to follow the same basic strategies for bone health that apply to others who don’t have the disease. These strategies include getting adequate calcium and vitamin D, performing weight-bearing exercise, not smoking, and avoiding excessive use of alcohol. In some cases, an osteoporosis treatment medication may be recommended.

A small percentage of people with celiac disease do not improve on a gluten-free diet. These people often have severely damaged intestines that cannot heal and may need to receive intravenous nutrition supplements.

Nutrition: A well-balanced diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Supplements can help ensure that the calcium requirement is met each day, especially in people with a proven milk allergy. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women, increasing to 1,200 mg for those age 50 and older.

Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. Food sources of vitamin D include egg yolks, saltwater fish, and liver. Many people obtain enough vitamin D naturally, by getting about 15 minutes of sunlight exposure each day. Older individuals—especially those who are housebound, live in northern climates, or use sunscreen—are often deficient in this vitamin and may need vitamin D supplements to achieve the recommended intake of 400 to 600 IU (International Units) each day.

Exercise: Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best kind of activity for your bones is weight-bearing exercise that forces you to work against gravity. Some examples include walking, climbing stairs, weight training, and dancing. These and other types of exercise also strengthen muscles that support bone, enhance balance and flexibility, and preserve joint mobility, all of which help reduce the likelihood of falling and breaking a bone, especially among older people.

Healthy lifestyle: Smoking is bad for bones as well as the heart and lungs. Women who smoke tend to go through menopause earlier, resulting in earlier reduction in levels of the bone-preserving hormone estrogen and triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol also can have a negative effect on bone health. Those who drink heavily are more prone to bone loss and fracture, because of both poor nutrition and increased risk of falling.

Bone density test: A bone mineral density (BMD) test measures bone density in various sites of the body. This safe and painless test usually can detect osteoporosis before a fracture occurs and predict one’s chances of fracturing in the future. Adults with celiac disease should talk to their doctors about whether they might be candidates for a BMD test. The test can help determine whether medication should be considered. A BMD test also can be used to monitor the effects of an osteoporosis treatment program.

Medication: Several medications are available to prevent and treat osteopo...

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