Ask the Expert: Women With Celiac Disease More Likely to Have Osteoporosis

Dr. Alissa Speziale

Dr. Alissa Speziale is a Sharp Rees-Stealy gastroenterologist. She explains why women have a greater risk for osteoporosis than men, and why women with an undiagnosed gastrointestinal (GI) disorder, such as celiac disease, have an  even higher risk of osteoporosis.

What is osteoporosis?
Osteoporosis is a condition in which the bones become less dense, leading to an increased risk of fracture. In the United States, more than 40 million people either have osteoporosis or are at high risk due to low bone mass. The diagnosis of osteoporosis is made by DEXA, or bone densitometry. This is a noninvasive test, and its results are discussed in comparison to peak bone density, the "T score." This will determine a patient's risk for fracture and if treatment is indicated.

Why are women at a higher risk for osteoporosis?
The reason is that women are born with a lower bone density than their male peers and they lose bone mass more quickly as they age. Additionally, undiagnosed GI disorders often cause nutritional deficiencies — in this case, a lower rate of vitamin D, calcium and magnesium absorption.

What is celiac disease?
Celiac disease is an inherited intestinal disorder in which the body cannot tolerate gluten, the protein in wheat, barley and rye. The diagnosis is made by blood test and a small bowel biopsy. Because it affects absorption of necessary minerals such as vitamin D, there is an increased risk of osteoporosis.

Celiac disease causes damage to the small intestine, which is responsible for absorbing important nutrients like calcium. Calcium is essential for building and maintaining healthy bones. Even people with celiac disease who consume sufficient amounts of calcium can be deficient.

What is a gluten intolerance?
A gluten intolerance should not be confused with a diagnosed GI disorder. Risk for osteoporosis is greatly reduced if the patient only has a gluten intolerance. Women who have had a bowel biopsy that came back positive for celiac disease are at the greatest risk.

The good news is there are treatments available to reduce your risk of osteoporosis.

What are treatment options for osteoporosis?
For women with celiac disease, the gluten-free diet improves absorption rates of the necessary nutrients and often leads to improvements in bone density.

If you feel you may be at risk for osteoporosis, or have an undiagnosed GI disorder, see your primary care physician. If they feel that it is necessary, they may refer you to a gastroenterologist. The best preventive care is to manage your calcium and vitamin D levels. Nutritionists recommend 1500 mg of Calcium and 800 IU of vitamin D daily. Additionally, exercise, smoking cessation and low alcohol use are important; and your doctor may prescribe medications to help prevent or treat both diseases.

For More Information
For more information about nutrition counseling, please call 619-740-4632. For more information about nutrition support services for patients, please call 619-740-4621. For health, wellness and weight management classes, please call 1-800-82-SHARP (1-800-827-4277).

To learn more about Sharp's nutrition services or to find a Sharp-affiliated physician, search for San Diego doctors or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm.