Patients with osteoporosis should be screened for celiac disease

Rates of celiac disease are significantly higher in patients with osteoporosis, according to researchers at Washington University School of Medicine in St. Louis. They recommend using blood tests to screen osteoporosis patients for celiac disease because their study has shown that treating celiac disease with diet can restore bone health in these patients.

Celiac disease is an intestinal disorder caused by intolerance to wheat flour (gluten). The investigators evaluated 840 people, 266 patients with osteoporosis and 547 without the bone disease. Through blood tests and endoscopic intestinal biopsies, they found nine osteoporosis patients also had celiac disease compared to only one of the 574 patients who didn’t have osteoporosis.

“Our results suggest that as many as three to four percent of patients who have osteoporosis have the bone disease as a consequence of having celiac disease, which makes them unable to absorb normal amounts of calcium and vitamin D,” says principal investigator William F. Stenson, M.D., a Washington University physician at Barnes-Jewish Hospital. The study is reported in the Feb. 28 issue of the Archives of Internal Medicine.

In celiac disease, an immune reaction to the gluten portion of wheat interferes with the intestine’s absorption of various dietary products. The disease can contribute to malnutrition and gastrointestinal problems. Removing gluten from the diet by excluding certain grain products corrects the condition. Although celiac disease often involves obvious symptoms such as weight loss and diarrhea, some patients do not know they have the disease because they experience only subtle problems such as iron deficiency anemia.

By putting patients who had celiac disease and osteoporosis on a gluten-free diet for one year, the investigators were able to improve gastrointestinal symptoms and improve bone density as well. “Bone density — which is the way bone health is measured — improved dramatically on a gluten-free diet,” Stenson says. “We believe the diet allowed intestines to heal and that permitted normal absorption normal of calcium and vitamin D to reverse bone loss.”

The improvement in bone density was greater than would have been expected for patients with osteoporosis on standard therapy.

Stenson, a professor of medicine at Washington University, says it’s not clear how common celiac disease is in the general population, but most health professionals believe the rate is higher than was previously thought. Celiac disease is detected much more in children than it once was, but Stenson says adults can develop the disease, too. “There is a genetic predisposition for celiac disease,” he says. “But many people don’t develop symptoms until later in life when they are exposed to something that triggers those genes to launch the disease.”

In this study, only 0.2 percent of people with healthy bones also had positive blood tests for celiac disease. The rate in people with osteoporosis was 4.5 percent. So Stenson and colleagues are recommending that when a patient is treated for osteoporosis, it might be worthwhile for their doctor to also order a blood test for celiac disease.

“One of our conclusions is that the incidence of celiac disease in patients with osteoporosis is high enough to justify screening for everybody with osteoporosis,” Stenson says. “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.”