Is there a relationship between osteoporosis and celiac disease?

Have you ever struggled with a health condition and wondered if the solution might be some simple thing, right under your nose, that you and your doctor have easily overlooked?

This might be the case for thousands of the 18 million people in the U.S. who have already been diagnosed with osteoporosis or have low bone mass, which places them at high risk of the disease.

Making the connection

Scientists already know there’s a much larger incidence of celiac disease (CD) among osteoporosis patients than that of the general population. CD is a digestive disorder triggered by gluten intake. Treatment for this condition is simple: remove gluten from the diet. But will CD treatment have any effect on osteoporosis?

This is the question that researchers from the Washington University School of Medicine in St. Louis set out to address when they recruited 840 subjects, 266 of whom had been diagnosed with osteoporosis. All subjects were screened for CD, and results were confirmed with intestinal biopsies. Those who tested positive for CD then underwent one year of treatment with a gluten-free diet. Bone mineral density tests were used to monitor osteoporosis.

The results: Severity of osteoporosis was found to correlate with severity of CD. More importantly, subjects who were treated with the special diet showed significant improvement in bone mineral density.

The lead researcher, William F. Stenson, M.D., offered this assessment in a Washington University press release: “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.”

Hiding out

Gluten is a typical component of several different grains. As a primary ingredient of flour, gluten delivers protein and gives bread a higher rise. The problem is that many people don’t tolerate gluten well, complicated by the fact that a good number of them aren’t even aware of their sensitivity.

But celiac disease is more than just sensitivity to gluten; it’s an auto-immune disorder in which gluten creates an obstruction to the absorption of nutrients in the small intestine. When CD goes untreated, malnutrition can develop, followed by a chronic condition that may trigger other dangerous ailments, including gastrointestinal cancer.

The problem with diagnosis of CD is that the symptoms are sometimes directly related to digestion (as with abdominal cramping, unexplained weight loss, and chronic diarrhea), but sometimes not (as with joint pain, and depression). If any of these symptoms occur in a patient with family history of CD, this should stand out as a red flag for any physician.

The primary treatment for celiac disease is adherence to a strict non-gluten diet. But this is easier said than done. High-gluten grains can be easily remembered with the mnemonic “BROW”: barley, rye, oat and wheat, but gluten is often hidden in some foods such as soups, soy sauce, low-fat or non-fat products, and even in candies such as jelly beans. Some common food ingredients that may contain gluten include: modified food starch, hydrolyzed vegetable or plant protein, and some binders and fillers, as well as malt and natural flavorings.

Enzyme helper

As Dr. Stenson pointed out, for a small fraction of osteoporosis patients CD may be a precursor of their condition. But that small fraction could equal thousands of patients in the U.S. alone. Needless to say, anyone with osteoporosis who has a family history of CD or sensitivity to gluten should talk with their doctor about the Washington University study to determine if a blood test to screen for CD is necessary.

Those who test positive may also want to talk with their doctors or healthcare providers about supplements that contain a plant-based enzyme called Aspergillus oryzae. A number of studies have shown that the enzyme may be effective in protecting the intestine from the effects of gluten. Formulas containing Aspergillus oryzae (such as Similase and Zest for Life Enzyme Boost Formula) are available from sources on the Internet.