Author information1Department of Nutritional Sciences, The University of Connecticut, Waterbury, CT 06702, USA. patricia.grace-farfaglia@uconn.edu.2Health and Wellness Promotion, Rocky Mountain University of Health Professions, Provo, UT 84606, USA. patricia.grace-farfaglia@uconn.edu.AbstractMetabolic bone disease is a frequent co-morbidity in newly diagnosed adults with celiac disease (CD), an autoimmune disorder triggered by the ingestion of dietary gluten. This systematic review of studies looked at the efficacy of the gluten-free diet, physical activity, nutrient supplementation, and bisphosphonates for low bone density treatment. Case control and cohort designs were identified from PubMed and other academic databases (from 1996 to 2015) that observed newly diagnosed adults with CD for at least one year after diet treatment using the dual-energy x-ray absorptiometry (DXA) scan. Only 20 out of 207 studies met the inclusion criteria. Methodological quality was assessed using the Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist.
Gluten-free diet adherence resulted in partial recovery of bone density by one year in all studies, and full recovery by the fifth year. No treatment differences were observed between the gluten-free diet alone and diet plus bisphosphonates in one study. For malnourished patients, supplementation with vitamin D and calcium resulted in significant improvement. Evidence for the impact of physical activity on bone density was limited. Therapeutic strategies aimed at modifying lifestyle factors throughout the lifespan should be studied. PMID: 25961322 PMCID: PMC4446755 DOI: 10.3390/nu7053347 [Indexed for MEDLINE] Free PMC ArticlePublication typeReviewMeSH termsBone Density*Bone Diseases, Metabolic/complicationsBone Diseases, Metabolic/therapy*Bone and Bones/metabolism*Bone and Bones/pathologyCeliac Disease/complications*Celiac Disease/diet therapyDiet, Gluten-Free*Diphosphonates/therapeutic useExerciseGlutens/administration & dosage*Glutens/adverse effectsHumansMicronutrients/pharmacologyMicronutrients/therapeutic use*SubstancesDiphosphonatesMicronutrientsGlutensFull Text SourcesMultidisciplinary Digital Publishing Institute (MDPI) - PDFEurope PubMed CentralPubMed CentralPubMed Central CanadaMedicalCeliac Disease - Genetic AllianceBone Density - MedlinePlus Health InformationCeliac Disease - MedlinePlus Health InformationVitamins - MedlinePlus Health InformationMiscellaneousGLUTEN -
Hazardous Substances Data BankNCI CPTC Antibody Characterization Program Bones of contention: Bone mineral recovery in celiac disease Low bone density is common in newly diagnosed patients with celiac disease (CD). Untreated CD leads to bone fractures and osteoporosis in young and older patients. The gluten-free diet (GFD) is the primary treatment for CD. Bone density does not fully recover during the first 12 months of the diet, and as a result clinicians question whether the current practice of nutritional supplementation is effective while the gut is still healing. Nutrient malabsorption due to the erosion of small intestine tissues, known as villus atrophy, is thought to be the major cause. This review of the literature looked at all of the potential variables that result in bone strengthening, such as diet, physical activity and nutritional supplementation. There was 20 high quality papers that reported the results of dual-energy X-ray absorptiometry (DXA) scans, also known as T-scores, at CD diagnosis and at least 12 months after treatment.
Healing times varied by age with full recover taking up to 5 years, with young patients responding much faster. In CD, long-term malnutrition from intestinal inflammation is common, but supplementation protocols varied by treatment center making comparisons more difficult. Because gluten-free grain-based products are generally not enriched with vitamins and minerals, many patients may benefit from supplementation with iron, folate, B12, vitamin D3, vitamin K, calcium, and magnesium. There are few studies on the effects of physical activity or physical inactivity on bone mass. The effects of exercise on bone density is a critical area for future study as the majority of new patients with CD are older adults and at high risk of falls and fractures. It is important for people with CD to get an individualized assessment by a Registered Dietitian Nutritionist to determine the type and amount of supplementation needed and get support through motivational counseling as they must adhere to the GFD for the rest of their life.
Rocky Mountain University of Health Professions, Health and Wellness Promotion, and University of Connecticut, Department of Nutritional Sciences Bones of contention: bone mineral density recovery in celiac disease–a systematic review. Log in to Taylor & Francis Online Or purchase it * 30 days access for USD 118.00 24 hours access for USD 50.00 * Local tax will be added as applicableOn her blog last week, the Oscar-winning actress Gwyneth Paltrow revealed that she "had the beginning stages if osteopenia" and has been advised to increase her vitamin D levels as a result. "My levels turned out to be the lowest they had ever seen," she claimed. "I went on prescription-strength levels and was told to spend a bit of time in the sun." It's a curious bit of advice; after all, the need to avoid exposure to ultraviolet rays is perhaps the most ubiquitous health message after that of not smoking. In fact, a moderate amount of sun-exposure can do a world of good – as Paltrow now knows only to well.
Rather than being a "disease" or "condition", osteopenia refers to a range of bone densities that are below average, but not as low as in osteoporosis, to which it's frequently seen as a likely precursor. A range of factors may lie behind the diagnosis; since our bones' renewal and repair slows with age, both conditions are most common in post-menopausal women and in elderly men with low levels of testosterone. In the UK, one in two women and one in five men over the age of 50 will break a bone mainly as a result of osteoporosis. But the possibility of weak bones is by no means limited to the over-50s. So what can be done to prevent it? Genetic predisposition plays a significant role in determining who will have low bone density, as do lifestyle factors: heavy drinking, smoking and caffeine consumption are all best avoided. Low body weight, low-calcium diets or a history of eating disorders can contribute, too – as can excessive exercise and, more commonly, a sedentary lifestyle.
Much has been made of the link with low vitamin D after Paltrow's diagnosis – and, while not necessarily the overriding cause behind osteoporosis, it is, says Thomson, a common problem: "Vitamin D is a very important player and, yes, we get it from the sun. It's a very difficult message as we don't want to encourage people to get outside and fry, but 20 minutes on the hands and face in the summer months is a good thing." Inevitably, living in cold climes, British women struggle with this more often that their southern-hemisphere counterparts: "In certain latitudes exposure is a lot more difficult. Whether that has a knock-on effect on osteopenia and osteoporosis has yet to be shown, but having the correct Vitamin D levels is definitely important." Although it's advisable to adopt early avoidance techniques, specialists don't generally recommend bone density testing until later in life, since most medical treatments aren't licensed below certain ages. In Paltrow's case, her bone-scan followed surgery that she was undergoing at the time.
Once diagnosed, osteopenia is unlikely to be treated with drugs. Instead patients are advised to stick to a balanced diet and engage in regular weight-bearing exercises such as running, aerobics, skipping. All these are excellent preventive measures, too. If the condition progresses to full-blown osteoporosis, a range of treatments become available. Hormone replacement therapy used to be the favoured method, but in recent years there's been a shift towards phosphonate-based drugs. Treatments have improved drastically in the past decade, leading to a notable enhancement in the quality of life for those diagnosed with osteoporosis. "We can reduce the risk of broken bones in osteoporosis patients by 50 per cent," says Thomson. "The drugs particularly aim to prevent injury to the hip and spine. Halving the risk of bone fractures really is significant – there is a lot to be positive about." * Approximately three million people in the UK have osteoporosis, which means literally "porous bones".