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Celiac Disease and Osteoporosis

Low bone mass, is common in patients with newly diagnosed CD. The mechanism for this effect may be due to malabsorption of vitamin D and calcium and decreased intake of calcium, because of lactose intolerance. Other factors such as sex, malnutrition and physical activity, also contribute to the risk of low bone density in CD.

Decrease in bone mineral density (BMD) associated with celiac disease responds to a GFD, with a gradual restoration to normal, over two years. The earlier in life that treatment is started, the better is the response. A limited number of screening studies for CD, among patients with low bone mass (LBM), have been performed in Europe.

Celiac disease was found in 3.4% in adults with LBM. However, a carefully performed Canadian study in predominantly postmenopausal women has not identifi ed an increased prevalence of CD. One likely explanation is the way the low bone mineral density is defined. Individuals with BMD more than 2.5 standard deviations below the sex-specific peak bone mass are presumed to have osteoporosis.

Therefore, it seems that screening those patients with simple postmenopausal osteoporosis, as defi ned by World Health Organization (WHO) criteria, is unhelpful. Recently, the risk of fractures due to osteoporosis has become a major subject of interest. celiac disease has been associated with an increase in fracture risk. What effect silent, undiagnosed CD, has on lifelong risk fracture risk, is not well known.

A large population-based cohort study performed in Great Britain showed that the overall hazard ratio in celiac disease patients for any fracture was 1.30 and 1.90 for hip fracture.

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