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What are the pathologic bone alterations in celiac disease?


This summary is basedon the article published in Nutrition: Pathologic bone alterations in celiac disease: Etiology, epidemiology, and treatment (January 2014, Supplement)


Low bone mineral density (BMD), osteopenia, and osteoporosis are frequent complications of celiac disease (CD). The etiology of pathologic bone alterations in CD is multifactorial; however, two main mechanisms are involved: intestinal malabsorption and chronic inflammation. A strict gluten-free diet (GFD) is thought to be the only effective treatment for CD; but treating bone complications related to CD remains complex.

Purpose of the Review

The review attempts to elucidate the bones problems related to CD and to increase awareness of osteoporosis development, considered as a sign of atypical CD presentation. Currently, a question of whether GFD alone is an effective treatment to correct the bone alterations in patients with CD is under debate. This review presents factors contributing to pathologic bone derangement, recent research on the epidemiology of low BMD, osteoporosis, and fractures, and the treatment of bone problems in patients with CD. The roles of calcium and transport mechanisms
are additionally presented.

Key Messages

  • A strict and lifelong GFD can help recover normal bone density when a diagnosis of CD is made in children and adolescents; however, there is no evidence that an optimal peak bone mass level can be achieved or that it can be maintained for many years, as happens in healthy individuals.
  • An early start to treatment for pediatric patients with CD ensures significantly higher bone metabolism rates because the treatment reverses the inflammatory process and prevents impairment of bone mass acquisition during the most important period for its acquisition.
  • In the case of adult CD patients diagnosed with bones disease, a GFD is still considered to be the most rational treatment approach. Nevertheless, a GFD rarely normalizes BMD in adulthood.
  • Bone alterations need to be considered as a sign of atypical CD presentation, especially in adults.
  • Recognizing CD, it’s possible connection with osteoporosis, and related fractures should always be taken into account.
  • The investigation on increased/corrected calcium intake, the use of vitamin D metabolites, and the drugs commonly given for primary osteoporosis are required.


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