John Libonati

Osteopenia Found in 50% of Children with Celiac Disease

by John Libonati on August 20th, 2009


gym_06Research shows celiac disease can cause brittle bones in children. Can a gluten-free diet correct it?

A teenage gymnast is completing an exercise at the US Nationals gymnastics competition. At seventeen years of age, she is one of the top athletes in the country, physically strong and incredibly fit.

Both her wrists fracture during the dismount.

Doctors test her bone density to find out why her bones broke so easily. Although she is just a teenager, she is diagnosed with osteopenia, the precursor to osteoporosis and a bone disorder that normally afflicts people over 55. She has never had gastrointestinal issues, but her doctors test her for celiac disease anyway because something is obviously wrong with the way she is absorbing and/or metabolizing calcium.

The result: Positive.

This true story was related to the author by the young woman. At this point, she was 24. She denied ever experiencing any of the symptoms that are frequently associated with celiac disease - no irritable bowel, no bloating, no diarrhea, no growth problems - yet chronic malabsorption of calcium and other nutrients had robbed her bones of the nutrients they needed to be strong.

What is Osteopenia?

Osteopenia is a metabolic bone disorder characterized by diminished bone mass with the retention of normal cell appearance and high bone turnover. The bones look normal on the outside, but are weak.1

Osteopenia results from defective calcium absorption, sometimes associated with lactose intolerance, increased body use of calcium, loss in stool and impaired vitamin D absorption.2 Other nutrients that may be deficient include copper, magnesium and vitamin K.1

Celiac disease, an immune response to partially digested gluten proteins found in wheat, barley, rye and oats that damages the lining of the small intestine, leads to malabsorption of nutrients.

It is well documented that the number of adult celiac disease patients with low bone density approaches 80 to 100%, but research among children with celiac disease shows osteopenia in childhood is extremely common among newly diagnosed patients and those who do not strictly follow a gluten-free diet.

Dr. Ayhan Gazi Kalayci and his researchers at Ankara University in Turkey found 50% of the children with celiac disease in their study had osteopenia. The average age of the children in the study was 11 years. The worst cases were the most newly diagnosed. Significant recovery occurred in children who followed a strict gluten-free diet.2

Another finding in untreated children with celiac disease, besides lower calcium levels, was significantly higher parathyroid hormones than were found in healthy children without celiac disease or patients on the gluten-free diet.2

Fortunately, removal of gluten from the diet results in rapid improvement of bone mineral density. Remarkable changes occur after the start of a strict gluten-free diet, and they result in a more balanced equilibrium.3 Low bone mineral density responds to successful dietary treatment in just 1 year and could be normalized in most patients.2 Although in some cases it may take as many as four years for a complete recovery. Early diagnosis and treatment of celiac disease, particularly during childhood, will protect patients from osteopenia.2

The increased potential for osteopenia in children with celiac disease is one more reason why it is so important to recognize atypical signs and symptoms of celiac disease. The gymnast mentioned above had none of the symptoms commonly associated with celiac disease. It was only by breaking her wrists that the disorder was discovered.

Identifying Osteopenia in Children

It is impossible to determine whether or not a person has osteopenia from their appearance. That said, recognizing signs of nutrient deficiencies is entirely possible. Things to look for in calcium deficiency include: poor development of bones and teeth, rickets in children, bone pain, easy fractures, muscle spasms/cramps, anxiety, irritability, insomnia, changes in saliva composition, excessive bleeding and seizures and laryngospasm when extreme. Signs of vitamin D deficiency in children include: development of rickets with bone bending of the weak shaft and delayed walking in 1 to 4 year olds. In older children, walking is painful with development of bowlegs and knock-knees. Other symptoms include bone pain, easy fractures, muscle weakness, defective coordination for walking and psoriasis.

Glutenfreeworks.com is a helpful resource for identifying symptoms related to celiac disease. The website lists over 300 signs, symptoms, associated disorders and complications stemming from and related to celiac disease in its Symptom Guide. The celiac disease reference Recognizing Celiac Disease details these 300 signs, listing the nutrient deficiencies that cause them.

1. Cleo J. Libonati, RN, BSN. Recognizing Celiac Disease. Ft. Washington, PA, USA: Gluten Free Works Publishing. 2007, p. 245. 2. Kalayci AG, Kansu A, Girgin N, Kucuk, O Aras G. Bone mineral density and importance of a gluten-free diet in patients with celiac disease in childhood. Pediatrics. Nov 2001: 108(5):e89 3. Kavak US, Yuce A, Kocak N, et al. Bone mineral density in children with untreated and treated celiac disease. Journal of Pediatric Gastroenterology and Nutrition. Oct 2003; 37(4):434-6. 4. Barera G, Beccio S, Proverbio MC, Mora S. Longitudinal changes in bone metabolism and bone mineral content in children with celiac disease during consumption of a gluten-free diet. American Journal of Clinical Nutrition. Jan 2004; 79(1):148-54.

—————— Author Information: John Libonati, Philadelphia, PA President-elect, Celiac Sprue Association (CSA). Publisher, Glutenfreeworks.com. Editor & Publisher, Recognizing Celiac Disease. John can be reached at john.libonati@glutenfreeworks.com.


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