Treatment Guide

Osteoporosis in Celiac Disease and How to Prevent It

osteoporosis celiac disease glutenOsteoporosis, or brittle bones, is a generalized bone disorder involving the slow loss of bone mass throughout the skeleton that results in diminished bone mineral density (BMD). Thinning, fragile bones maintain normal cell appearance but have a rapid turnover so that more bone is taken up and removed than is laid down. The result is bone weakness that predisposes people with osteoporosis to fractures.

Osteopenia refers to the progression of bone tissue loss in the range between normal to osteoporosis.

What are Bones?

Bones are dynamic structures made up of living connective tissue and certain minerals. Connective tissue provides the shape of bones and holds calcium phosphate mineral for hardness and strength. Connective tissue is made up mostly of collagen, a strong, fibrous protein.  Bone tissue is not static but is constantly replaces old or damaged bone with new bone.

The outer surface of all bones and the shafts of long bones are made up of compact cortical bone tissue. An inner, porous portion, called cancellous or spongy bone, is made up of connective tissue composed of bone cells called osteocytes. Osteocytes are embedded in a matrix of calcified substance called trabeculae. The two opposing types of bone cells are osteoblasts and osteoclasts.

Osteoclast activity takes up bone and osteoblast activity lays down bone. Osteoclasts are large cells in the bone marrow that absorb calcium salts in remodeling bone. Osteoblasts are cells that form bone where needed for repair or growth. In osteoporosis, osteoclast activity is heightened and osteoblast activity is diminished.

Bone loss affects both cortical bone and spongy bone. It reduces the thickness of cortical bone and the number and size of the trabeculae in spongy bone.

How common is Osteoporosis?

  • In the general population, 44 million people have either osteoporosis or low bone mass, representing 55 percent of the people aged 50 and older in the United States.


  • A study of women at diagnosis of CD that included both fertile (young) and postmenopausal women, demonstrated 40% with osteopenia, 26% with osteoporosis, and 34% with normal bone mineral density.

What are the causes in Celiac Disease?

Osteoporosis is induced by deficiencies of calcium and vitamin D. Deficiency of other nutrients such as protein, copper, iron, magnesium, manganese, vitamin K and selenium contribute.

  1. A study investigating the cause of bone loss and weakening in celiac disease patients demonstrated that bone weakening might result from 1) metabolic disturbances of bone remodeling affecting trabecular and cortical bone masses and the mechanical quality of the bone material, and 2) a reduction of muscle strength impairing the optimization of bone architectural design and mass of cortical bone. Gluten-free diet seems to correct almost exclusively the metabolically induced disturbances.
  1. A study evaluating the impact of a 1 year gluten-free diet on bone metabolism and nutritional status in newly diagnosed celiac disease patients demonstrated that celiac disease patients are at high risk for developing a low bone mineral density and bone turnover impairment. A one year gluten-free diet improved this situation in the 57% who showed mucosal recovery.
  1. A study evaluating 266 patients with and 574 patients without osteoporosis demonstrated the prevalence of celiac disease in osteoporosis is high enough to justify a recommendation for screening of all patients with osteoporosis for celiac disease.

What are additional risk factors for people with Celiac Disease?

Osteoporosis is sometimes referred to as the “silent thief” because there are typically no symptoms while bone loss progresses, and with it, increased risk of fractures and falls.

  • Diet low in calcium
  • Small, thin frame
  • Asian or Caucasian
  • Early menopause
  • Sedentary lifestyle (low physical activity)
  • Smoke or drink to excess
  • Thyroid medication
  • Cortisone-like drugs for more than 3 months

How can I tell if I have Osteoporosis?

Signs include back pain and skeletal deformities such as the so-called “dowager’s hump” or an “S” shaped curvature of the spine, and loss of height, especially if compression fractures of the vertebrae occur. The jawbone shrinks as well. Complications include loss of mobility and disability from fractures. Certain fractures may precipitate premature death, as for example, hip fractures that result in infection, pneumonia and shock.

Is there a medical test to screen for Osteoporosis?

Talk to your doctor about getting a bone density scan. According to the National Institutes of Health, bone density should be measured in adults at diagnosis of celiac disease. It would be best to consult an endocrinologist who is also familiar with celiac disease for follow-up.

A bone density scan is a safe, quick and painless way to get the information that you need. It requires that you lie on a table under a small scanning arm while the machine uses x-rays or sound waves to scan your spine and hip bones. Results of a yearly bone density scan can be used to:

  • Detect osteoporosis before a fracture occurs
  • Predict chances of fracture in the future
  • Determine the rate of bone loss
  • Monitor effects of treatment after at least one year

What can I do about Osteoporosis?

To slow or prevent bone loss and build bone, increase calcium, vitamin D and protein and get regular exercise.

  • Include foods rich in calcium, vitamin D, and protein in your diet.
  • Consider calcium supplements to boost your calcium to between 1,000 and 1,300 mg a day.
  • Organize a strength training program for your bones that includes weight-bearing, resistance, and range-of motion exercises. First, pull your breastbone up as though a rope was attached at a higher point.  This is the most important action you can take to straighten your back and that allows you to pull your shoulders back also. These two actions will take strain off the neck and shoulder muscles so you can best benefit by exercise. Pulling the shoulders back without pulling up the breastbone does not improve posture.
    • Weight-bearing require your feet and legs to bear your weight, such as walking or gently jogging 2 miles a day.
    • Resistance exercises make muscles work against a force, such as weight lifting according to doctor’s advice.
    • Range-of-motion exercises keep joints functioning normally, such as aerobics.

To prevent stress fractures and falls, learn and use proper body mechanics.

  1. Sleep on a firm mattress to keep body in alignment while sleeping.
  2. Use assistive devices to prevent losing balance by overreaching for high things or trying to pick up low things.

Osteoporosis is preventable and treatable. Start now to protect your bones.


Libonati, C. Recognizing Celiac Disease. GFWorks Publishing. 2007.

Surgeon General’s Report on “Bone Health and Osteoporosis.”

National Digestive Diseases Information Clearinghouse. “Celiac Disease”.


About Cleo Libonati, RN, BSN

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Cleo Libonati, RN, BSN is CEO and co-Founder of Gluten Free Works, Inc. and She is the author and publisher of the highly recommended celiac disease reference guide, Recognizing Celiac Disease.


  1. Very informative article. I have Osteopenia as a result of my undiagnosed celiac, and trying to avoid Osteoporosis. Great tips mentioned above. Thank you.

  2. I also have CD and follow a GFdiet for 7years now. I have important osteoporosis and after consulting rhumatologist, I decided not to accept zoledronic acid drug they advice me to take. This drug has a lot of side effect and I am not sure, I am at risk of fracture .

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