Researchers Offer the Latest on Celiac Disease and Osteoporosis

Celiac.com 06/06/2023 - Celiac disease, osteopenia  and osteoporosis are conditions that have been found to be connected. A research team recently described celiac disease-induced osteoporosis in an attempt to enlighten new and lesser-known aspects, including the influence of the intestinal microbiome and sex-related differences, on bone health. 

The team included Lisa Lungaro, Francesca Manza, Anna Costanzini, Marianna Barbalinardo, Denis Gentili, Fabio Caputo, Matteo Guarino, Giorgio Zoli, Umberto Volta, Roberto De Giorgio, and Giacomo Caio.

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They are variously affiliated with the Department of Translational Medicine, University of Ferrara in Ferrara, Italy; the National Research Council, Institute for the Study of Nanostructured Materials (CNR-ISMN) in Bologna, Italy; the Department of Medical and Surgical Sciences, University of Bologna, in Bologna, Italy; the Mucosal Immunology and Biology Research Center, Massachusetts General Hospital—Harvard Medical School in Boston, MA, USA.

Their review describes the role of celiac disease in the development of skeletal alterations, in order to provide physicians with an updated overview on this debated topic, and to improve the management of osteoporosis in celiac disease.

It is important to note that not all individuals with celiac disease will develop osteoporosis. The risk varies depending on factors such as the duration and severity of the disease, adherence to a gluten-free diet, and individual variations in bone health and genetics. 

However, individuals with celiac disease should be aware of the increased risk of osteoporosis and take steps to manage their bone health, including ensuring adequate calcium and vitamin D intake, monitoring bone density through regular screenings, and maintaining strict adherence to a gluten-free diet. 

Several important connections between the conditions highlighted by the researchers include:

Malabsorption

Celiac disease is characterized by damage to the small intestine, leading to impaired absorption of nutrients, including calcium and vitamin D, which are essential for maintaining healthy bones. Malabsorption of these nutrients can result in reduced bone mineral density and increased risk of osteoporosis.

Inflammatory Response

Celiac disease triggers an immune response in the presence of gluten. This immune response involves the production of pro-inflammatory molecules, which can contribute to bone loss and increased bone turnover, leading to osteoporosis.

Calcium Imbalance

The malabsorption of calcium in individuals with celiac disease can disrupt the balance of calcium in the body. When there is insufficient calcium intake or absorption, the body may draw calcium from the bones, weakening them and increasing the risk of osteoporosis. Calcium intake in the young age is an essential determinant of the bone mass peak. Calcium metabolism defects are common in untreated children with celiac disease, and they return to normal with a gluten-free diet.

Vitamin D Deficiency

Vitamin D plays a crucial role in calcium absorption and bone health. Celiac disease can lead to reduced vitamin D absorption due to intestinal damage. Vitamin D deficiency further exacerbates the risk of osteoporosis.

Gluten-Induced Autoimmunity

Celiac disease is an autoimmune disorder, and individuals with autoimmune diseases, including celiac disease, have a higher risk of developing additional autoimmune conditions such as autoimmune osteoporosis. Autoimmune mechanisms may contribute to bone loss and the development of osteoporosis in individuals with celiac disease.

Hormonal Imbalance

Celiac disease can disrupt the endocrine system, leading to hormonal imbalances. Hormones such as estrogen and testosterone play a crucial role in maintaining bone health. Imbalances in these hormones can accelerate bone loss and increase the risk of osteoporosis.

Sex Differences

Women with celiac disease are at a higher risk of osteoporosis due to both indirect and direct effects. The indirect effects include factors such as early menopause and amenorrhea (absence of menstruation), which can have a negative impact on bone health. Early menopause refers to the cessation of menstruation before the age of 45, which can occur in women with celiac disease due to various factors, including hormonal imbalances and inflammation.

Early menopause is concerning for bone health because estrogen, a hormone that helps maintain bone density, decreases significantly during menopause. Lower estrogen levels can accelerate bone loss and increase the risk of osteoporosis. Therefore, women with celiac disease who experience early menopause should be particularly vigilant about managing their bone health.

Physicians should be aware of bone conditions linked to celiac disease that might contribute to the worsening of BMD, and should treat them promptly. 

There is little evidence regarding osteopenia and pharmacological osteoporosis treatment, specifically in celiac disease. Probiotic supplementation might become a novel strategy in preventing bone alterations, although the role of gut microbiota is still uncertain and not well-established yet. 

In the full report, the researchers offer a comprehensive dive into each of the areas mentioned above.

Read more in Nutrients. 2023 Mar; 15(5): 1089
doi: 10.3390/nu15051089