{"id":776,"date":"2013-04-29T19:39:10","date_gmt":"2013-04-29T23:39:10","guid":{"rendered":"http:\/\/www.mynutriguide.com\/?p=776"},"modified":"2019-12-26T12:44:09","modified_gmt":"2019-12-26T17:44:09","slug":"osteomalacia-3","status":"publish","type":"post","link":"https:\/\/glutenfreeworks.com\/health\/osteomalacia-3\/","title":{"rendered":"Osteomalacia"},"content":{"rendered":"<div id=\"attachment_6910\" style=\"width: 310px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/068.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-6910\" class=\"size-medium wp-image-6910\" src=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/068-300x200.jpg\" alt=\"The woman's legs second from the right show bowing in osteomalacia.\" width=\"300\" height=\"200\" srcset=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/068-300x200.jpg 300w, https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/068-1024x682.jpg 1024w, https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/068.jpg 1440w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-6910\" class=\"wp-caption-text\">The legs second from the right show bowing in osteomalacia in contrast to the others.<\/p><\/div>\n<h2>What Is Osteomalacia?<\/h2>\n<p style=\"text-align: justify\"><span class=\"dropcap\">O<\/span>steomalacia is a metabolic bone disorder\u00a0<span style=\"line-height: 1.5em\">that causes abnormal skeletal changes\u00a0<\/span><span style=\"line-height: 1.5em\">characterized by generalized reduction in bone density (bone softening) in adults and pseudofractures (apparant on x-ray) with muscular weakness and bone tenderness.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"line-height: 1.5em\">Bones have the normal amount of living collagen tissue that make up their structure but lack adequate <\/span><span style=\"line-height: 1.5em\">calcium and phosphorus minerals that are required for strength. <\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"line-height: 1.5em\">Blood studies show the level of parathyroid hormone (PTH), which maintains calcium and phosphorus balance in the body, and the enzyme bone alkaline phosphatase (BALP), which breaks down bone, are elevated while calcium and phosphorus are decreased. Bone biopsy gives the definitive diagnosis.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"color: #000000\"><strong>Q:<\/strong><\/span> How do bones get soft?<\/p>\n<p style=\"text-align: justify\"><span style=\"color: #000000\"><strong>A:<\/strong>\u00a0<\/span>Bones get soft because the normal process of depositing minerals in bone tissue is defective. Bone is continually being remodelled. This is the normal process of breaking down small areas of weak or fractured bone and replacing with healthy bone. The unique cells that break down or dissolve damaged bone are called osteoclasts and cells that build new bone in its place are osteoblasts.<\/p>\n<p style=\"text-align: justify\">In the condition of osteomalacia, there is not adequate\u00a0<span style=\"line-height: 1.5em\">calcium and phosphorus to strengthen new bone made by the osteoblasts and this is the result of inadequate vitamin D. The result is soft bones and weak muscles that worsen as the condition progresses.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"line-height: 1.5em\">The main causes of vitamin D deficiency include<\/span><span style=\"line-height: 1.5em\">\u00a0malabsorption, poor diet, lack of sunshine, and disorders of vitamin D metabolism.<\/span><span style=\"line-height: 1.5em\">\u00a0<\/span><span style=\"line-height: 1.5em\">Osteomalacia can also be a feature of systemic disorders such as hyperparathyroidism, partial gastrectomy, pancreatic disease, kidney disease, biliary disease and inflammatory bowel disease. Osteomalacia may be induced by tumors and drugs such as bisphosphonates and certain anti-seizure medications.<\/span><\/p>\n<h2>What Is Osteomalacia In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<p><!--more--><\/p>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify\"><strong>Relationship between osteomalacia and celiac disease.<\/strong> Osteomalacia is a serious complication in celiac disease and can be a presenting feature of celiac disease.<\/li>\n<li style=\"text-align: justify\"><strong>Relationship between osteomalacia and missed diagnosis.\u00a0<\/strong>The presentation of vitamin D deficiency causing osteomalacia can be varied and a high index of suspicion is important for treatment of this common, but frequently misdiagnosed, condition.<a href=\"#footnote_1_776\" id=\"identifier_1_776\" class=\"footnote-link footnote-identifier-link\" title=\"Mittal R, Kalra P, Dharmalingam M. Vitamin D deficiency presenting like hypophosphatemic osteomalacia. Indian J Endocrinol Metab. 2012 Dec;16(Suppl 2):S413-5. doi: 10.4103\/2230-8210.104112.\">1<\/a><\/li>\n<\/ul>\n<h2>How Prevalent Is Osteomalacia In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<ul class=\"cp_bullet black\">\n<li style=\"text-align: justify\">Osteomalacia is common in patients with untreated celiac disease.<a href=\"#footnote_2_776\" id=\"identifier_2_776\" class=\"footnote-link footnote-identifier-link\" title=\"Arnala I, Kemppainen T, Kroger H, Janatuinen E, Alhava EM. Bone histomorphology in celiac disease. Annales Chirurgiae Et Gynaecologiae. 2001;90(2):100-4.\">2<\/a><\/li>\n<li style=\"text-align: justify\">Eight percent (8%) of patients who were diagnosed with celiac disease at\u00a0a hospital endocrinology department were shown by X-ray to have osteomalacia or rickets.<a href=\"#footnote_3_776\" id=\"identifier_3_776\" class=\"footnote-link footnote-identifier-link\" title=\"Philip R, Patidar P, Saran S, Agarwal P, Gupta K. Endocrine manifestations of celiac disease. Indian J Endocrinol Metab. 2012 December; 16(Suppl 2): S506&ndash;S508.\">3<\/a><\/li>\n<li style=\"text-align: justify\">Low bone mineral density shown by Dexa scan is common in newly diagnosed adult celiac patients with approximately one fifth of them having low vitamin D level.<a href=\"#footnote_4_776\" id=\"identifier_4_776\" class=\"footnote-link footnote-identifier-link\" title=\"Chakravarthi SD, Jain K, Kochhar R, Bhadada SK, Khandelwal N, Bhansali A, Dutta U, Nain CK, Singh K. Prevalence and predictors of abnormal bone mineral metabolism in recently diagnosed adult celiac patients.&nbsp;Indian J Gastroenterol.&nbsp;2012 Jul;31(4):165-70. Epub 2012 Aug 11.\">4<\/a><\/li>\n<\/ul>\n<h2>What Are The Symptoms Of Osteomalacia?<\/h2>\n<ul class=\"cp_bullet red\">\n<li style=\"text-align: justify\">Bone pain (dull, achy)\u00a0that is symmetrical and worsens with physical activity and movement:\u00a0in the lower spine, hips, and pelvis so it hurts to sit; in the legs so it hurts to stand, and the feet so it hurts to walk. \u00a0Ribs also are commonly affected.<\/li>\n<li style=\"text-align: justify\">Bone tenderness that may result in severe pain with pressure or just by lightly touching or rubbing.<\/li>\n<li style=\"text-align: justify\">Muscle weakness\u00a0&#8211; thighs and upper arms and stiffness, especially difficulty in getting up from squatting posture and climbing stairs or getting up out of a chair.<\/li>\n<li style=\"text-align: justify\">Waddling gait due to increased joint spaces.<\/li>\n<li style=\"text-align: justify\">Bone deformities in the pelvis &#8211; broadening of the pelvis at the hips and narrowing front to back develops.<\/li>\n<li style=\"text-align: justify\">Deformities in knees &#8211; bowing out of the knees (bowlegs) or bowing in of the knees (knocknees) develops.<\/li>\n<li style=\"text-align: justify\">Risk of fractures, especially of wrist and pelvis.<\/li>\n<li style=\"text-align: justify\">Compression fractures of the spine cause kyphosis (hunchback), a barrel chest, and loss of height due to shortening of the spine as the disease advances.<\/li>\n<li style=\"text-align: justify\">Fatigue.<\/li>\n<li style=\"text-align: justify\">Difficulty sleeping\/insomnia.<\/li>\n<li style=\"text-align: justify\">Loss of appetite.<\/li>\n<\/ul>\n<h2>How Does Osteomalacia Develop In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify\">Osteomalacia results from calcium reduction in bone tissue (too little) caused by vitamin D deficiency due to malabsorption in celiac disease.<\/li>\n<li style=\"text-align: justify\">Defective use of vitamin D in the body. The main biological effect of vitamin D is to increase calcium absorption by the gut and mobilize mineral from the bone. The\u00a0effects on renal tubules are to inhibit calcium resorption (losing) and the opposite effect to encourage phosphate resorption (saving).<a href=\"#footnote_1_776\" id=\"identifier_5_776\" class=\"footnote-link footnote-identifier-link\" title=\"Mittal R, Kalra P, Dharmalingam M. Vitamin D deficiency presenting like hypophosphatemic osteomalacia. Indian J Endocrinol Metab. 2012 Dec;16(Suppl 2):S413-5. doi: 10.4103\/2230-8210.104112.\">1<\/a><\/li>\n<\/ul>\n<h2>Does Osteomalacia Respond To Gluten-Free Diet?<\/h2>\n<p style=\"text-align: justify\">Osteomalacic bone changes may not respond to a gluten free diet.<a href=\"#footnote_5_776\" id=\"identifier_6_776\" class=\"footnote-link footnote-identifier-link\" title=\"Arnala I, Kemppainen T, Kroger H, Janatuinen E, Alhava EM. Bone histomorphology in celiac disease. Annales Chirurgiae Et Gynaecologiae. 2001;90(2):100-4.\">5<\/a> However, pain decreases and muscle strength improves which may be dramatic.<a href=\"#footnote_6_776\" id=\"identifier_7_776\" class=\"footnote-link footnote-identifier-link\" title=\"Rabelink NM, Westgeest HM, Bravenboer N, Jacobs MA, Lips P. Bone pain and extremely low bone mineral density due to severe vitamin D deficiency in celiac disease.&nbsp;Arch Osteoporos. 2011 Dec;6(1-2):209-13. doi: 10.1007\/s11657-011-0059-7.\">6<\/a>,<a href=\"#footnote_7_776\" id=\"identifier_8_776\" class=\"footnote-link footnote-identifier-link\" title=\"Byrne MF, Razak AR, Leader MB, Sheehan KM, Patchett SE. Disabling osteomalacic myopathy as the only presenting feature of coeliac disease.&nbsp;Eur J Gastroenterol Hepatol. 2002 Nov;14(11):1271-4.\">7<\/a><\/p>\n<h2 style=\"text-align: justify\">6 Steps To Improve Osteomalacia In Celiac Disease and\/or Gluten Sensitivity:<\/h2>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><span class=\"dropcap\"><strong>1<\/strong><\/span><\/span><strong><span style=\"color: #800000\">Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<b>Treatment<\/b>. This condition responds to the complete elimination of gluten, which is the required treatment that improves both bone and gut health.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.<\/li>\n<li>A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.<\/li>\n<li>Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1\/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Correct Your Individual Nutritional Needs.<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Eat foods that can replenish missing nutrients. Find them under\u00a0NUTRIENT DEFICIENCIES.<\/li>\n<li>Take nutritional supplements as needed.\u00a0Find them under\u00a0NUTRIENT DEFICIENCIES.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Recovery<\/strong>. You should begin to feel better within a week and notice more energy as inflammation subsides and the \u00a0absorbing cells that make up the surface lining of your small intestine are better able to function.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.<\/li>\n<li>Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.<a href=\"#footnote_8_776\" id=\"identifier_9_776\" class=\"footnote-link footnote-identifier-link\" title=\"Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.&nbsp;Clinical Science. Apr 2001;100(4):379-86.\">8<\/a><\/li>\n<li>The intestinal lining may take up to a year to heal.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><span class=\"dropcap\"><strong>2<\/strong><\/span><\/span><strong><span style=\"color: #800000\">\u00a0Reduce Inflammation. Foods to Eat and Foods Not to Eat:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\">Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).<\/p>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Here Are Major Inflammatory Food Types That Reduce Healing<\/strong>:<\/p>\n<ul class=\"cp_bullet red\" style=\"text-align: justify\">\n<li><strong>Damaging Foods<\/strong>. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.<a href=\"#footnote_9_776\" id=\"identifier_10_776\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">9<\/a><\/li>\n<li><strong>Allergenic Foods<\/strong>. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.<\/li>\n<li><strong>Shelf Stable Processed Foods.\u00a0<\/strong>Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_9_776\" id=\"identifier_11_776\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">9<\/a><\/li>\n<li><strong>Fats.<\/strong>\u00a0Limit deep fried foods, trans-fats, saturated fats (animal fat\/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.<a href=\"#footnote_9_776\" id=\"identifier_12_776\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">9<\/a>.<\/li>\n<li><strong>Excessive Refined White Flours\u00a0<\/strong>(bran layer removed)<strong>.\u00a0<\/strong>Includes\u00a0products made from them such as cookies, bread, cakes, pies.\u00a0Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream.\u00a0Also disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_9_776\" id=\"identifier_13_776\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">9<\/a><\/li>\n<li><strong>Refined Sugars.\u00a0<\/strong>\u00a0Includes white sugar, corn fructose and high fructose corn syrup.<\/li>\n<li><strong>Certain Spices<\/strong>. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_9_776\" id=\"identifier_14_776\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">9<\/a><\/li>\n<li><strong>Alcohol and Caffeine<\/strong>. Disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_9_776\" id=\"identifier_15_776\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">9<\/a>\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Here Are Important Anti-Inflammatory Food Types to Promote Health<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li><strong>Fruits<\/strong>.\u00a0Contain ample amounts of vitamins, minerals and phytochemicals which are\u00a0naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.<\/li>\n<li><strong>Non-Starchy Vegetables.<\/strong>\u00a0Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.<\/li>\n<li><strong>High Quality Complex Carbohydrates<\/strong>. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.<\/li>\n<li><strong>Antioxidants<\/strong>. Protect the body from inflammatory oxidant molecules that continually occur and\u00a0help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as\u00a0nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.<\/li>\n<li><strong>Omega-3 Fatty Acids<\/strong>. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.<\/li>\n<li><strong>Probiotics.\u00a0<\/strong>Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.<\/li>\n<li><strong>Prebiotics\/ High Fiber Foods<\/strong>. \u00a0Food with fiber keeps our population of colonic microbes healthy.<\/li>\n<li><strong>Protective Herbs and Spices<\/strong>. \u00a0See below #6 below for examples.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><strong><span class=\"dropcap\">3<\/span>\u00a0Information Sheet You Can Take to Your Doctor or Other Health Professional:<\/strong><\/span><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\">Click here.<\/p>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><span style=\"color: #800000\"><strong><em><span class=\"dropcap\">4<\/span>\u00a0Manage Your Medications\u00a0Safely<\/em>:<\/strong><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p style=\"text-align: justify\">Certain medications deplete vitamin D which promotes osteomalacia. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below.\u00a0<strong>Do not stop prescribed medications without supervision.<\/strong><\/p>\n<p>\u00a0This is not a complete listing.<\/p>\n<p style=\"text-align: justify\"><strong>ANTACIDS \/ ULCER MEDICATIONS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Pepcid\u00ae, Tagamet\u00ae, Zantac\u00ae deplete Vitamin D.<\/li>\n<li>Magnesium and Aluminum Antacid preparations (Gaviscon\u00ae, Maalox\u00ae, Mylanta\u00ae) deplete\u00a0Vitamin D.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTI-INFLAMMATORIES<\/strong>\u00a0disrupt intestinal permeability which complicates celiac disease.<\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Corticosteroids (Prednisone, Medrol\u00ae, Aristocort\u00ae, Decadron) deplete Vitamin D.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTICONVULSANTS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Phenobarbital and Barbituates; and Dilantin\u00ae, Tegretol\u00ae, Mysoline\u00ae, Depakane\/Depacon\u00ae deplete Vitamin D.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>CHOLESTEROL DRUGS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Colestid\u00ae and Questran\u00ae deplete Vitamin D.<\/li>\n<\/ul>\n<p><strong>WEIGHT LOSS DRUGS THAT BIND FAT\u00a0<\/strong>also interfere with absorption of some nutrients.<\/p>\n<ul class=\"cp_bullet blue\">\n<li>Zenicol (Orlistat\u00ae) depletes Vitamin D.<\/li>\n<\/ul>\n<p><span style=\"text-align: justify\">\n\t\t\t<\/div><\/div><\/span><\/p>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><strong><span class=\"dropcap\">5<\/span>Nutritional Supplements To Help Correct Deficiencies:<\/strong><\/span><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p style=\"text-align: justify\">The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.<\/p>\n<ul class=\"cp_bullet orange\" style=\"text-align: justify\">\n<li>Multivitamin\/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.<\/li>\n<li>Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.<\/li>\n<li>Vitamin D3 as prescribed following blood test for status.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Storage Note<\/strong>:\u00a0<em>Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet &#8211; not in the bathroom or on the kitchen table<\/em>.\n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><span style=\"color: #800000\"><em><strong><span class=\"dropcap\">6<\/span>Manage Natural Remedies:\u00a0<\/strong><\/em><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Hydration<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.<\/li>\n<li>If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.<\/li>\n<li>Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.<\/li>\n<li>What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Carminatives.\u00a0<\/strong>The following \u00a0anti-inflammatory\u00a0plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.<\/p>\n<p style=\"text-align: justify\"><strong>Carminative Food Remedies<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Raspberry.<\/li>\n<li>Carrot is also a cleansing digestive tonic.<\/li>\n<li>Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.<\/li>\n<li>Redbeets also stimulate and improve digestion and are easily digested.<\/li>\n<li>Cabbage also stimulates and improves digestion and is also a liver decongestant.<\/li>\n<li>Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.<\/li>\n<li>Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Carminative Herb Remedies:<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. \u00a0Drink as tea or use in cooking.<\/li>\n<li>Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.<\/li>\n<li>Parsley also relieves indigestion.<\/li>\n<li>Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.<\/li>\n<li>Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Carminative Spice Remedies:<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Cloves are also antispasmodic.<\/li>\n<li>Nutmeg is also useful for indigestion.<\/li>\n<li>Ginger.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Exercise Helps<\/strong>:<\/p>\n<p style=\"text-align: justify\">Exercise improves circulation and rids the body of toxins.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Walking is aerobic exercise that reconditions the whole body to improve stamina.\u00a0Read more about<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">\u00a0Exercise and Fitness<\/a>.<\/li>\n<li>Weight training builds muscle.\u00a0Read more about\u00a0<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">Exercise and Fitness<\/a>.<\/li>\n<li>Stretching improves flexibilty.\u00a0Read more about\u00a0<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">Exercise and Fitness<\/a>.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Note<\/strong>: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. \n\t\t\t<\/div><\/div>\n<h2>What Do Medical Research Studies Tell About Osteomalacia In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<h4><strong>RESEARCH STUDY SUMMARIES<\/strong><\/h4>\n<p style=\"text-align: justify\">&#8220;<strong>Prevalence and predictors of abnormal bone mineral metabolism in recently diagnosed adult celiac patients<\/strong>.&#8221; This study investigating the prevalence of low bone mineral density (BMD) in recently diagnosed adult celiac patients and aiming to identify the factors associated with this found that low BMD is common in newly diagnosed adult celiac patients with approximately one fifth of them having osteoporosis and low vitamin D level.<\/p>\n<p style=\"text-align: justify\">BMD was measured in 54 newly diagnosed adult celiac patients between February 2008 and April 2009 and its correlation with clinical and biochemical parameters was analyzed. Fifty-four (24 male) newly diagnosed celiac patients ages 18-50 were included. Thirty-nine (72.2 %) presented with intestinal symptoms and the rest with extraintestinal symptoms. Low vitamin D levels were seen in 11 (20.3 %) patients and elevated iPTH (secondary hyperparathyroidism) in 12 (22.2 %) patients. Twenty-one (39 %) patients had normal BMD, 23 (43 %) had osteopenia (T-score -1 to -2.5), and 10 (18 %) patients had osteoporosis (T-score &lt;-2.5). A statistically significant association was seen between BMD and age of onset, duration of illness, serum tTGA levels, serum vitamin D levels, and cellular changes seen on biopsy. BMD should be measured in all newly diagnosed celiac patients and calcium and vitamin D supplementation included in the treatment regimen.<a href=\"#footnote_10_776\" id=\"identifier_16_776\" class=\"footnote-link footnote-identifier-link\" title=\"Chakravarthi SD, Jain K, Kochhar R, Bhadada SK, Khandelwal N, Bhansali A, Dutta U, Nain CK, Singh K. Prevalence and predictors of abnormal bone mineral metabolism in recently diagnosed adult celiac patients.&nbsp;Indian J Gastroenterol.&nbsp;2012 Jul;31(4):165-70.\">10<\/a><\/p>\n<p style=\"text-align: justify\"><strong>&#8220;Endocrine manifestations of celiac disease.&#8221;\u00a0<\/strong>This study investigating the prevalence of endocrinopathies in 36 patients who were diagnosed with celiac disease at\u00a0a hospital endocrinology department found\u00a0short stature (58%), delayed puberty (31%), elevated alkaline phospahatase (67%), low calcium (22%), X-rays suggestive of osteomalacia or rickets (8%), carpopedal spasm (6%), and night blindness (6%). Anti-TPO antibody positivity was found in 53%, hypothyroidism in 28%, subclinical hypothyroidism in 17%, and type-1 DM in 25% of the patients. A total of 14% patients had no GI symptoms.<a href=\"#footnote_11_776\" id=\"identifier_17_776\" class=\"footnote-link footnote-identifier-link\" title=\"Philip R, Patidar P, Saran S, Agarwal P, Gupta K. Endocrine manifestations of celiac disease.&nbsp;Indian J Endocrinol Metab. 2012 December; 16(Suppl 2): S506&ndash;S508.\">11<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cBone histomorphology in celiac disease.\u201d<\/strong> This study investigating bone metabolism in celiac patients demonstrated that static and dynamic histomorphometry of iliac crest bone biopsy are useful tools to evaluate bone metabolism in celiac disease, especially if hyperparathyroidism or mineralization defect are suspected. Hyperparathyroidism may be a problem in patients before introducing a gluten free diet.\u00a0Mineralization defect and osteomalacic changes are common later on, irrespective of whether the patients are in remission or not.<a href=\"#footnote_5_776\" id=\"identifier_18_776\" class=\"footnote-link footnote-identifier-link\" title=\"Arnala I, Kemppainen T, Kroger H, Janatuinen E, Alhava EM. Bone histomorphology in celiac disease. Annales Chirurgiae Et Gynaecologiae. 2001;90(2):100-4.\">5<\/a><\/p>\n<p style=\"text-align: justify\"><strong>&#8220;Osteomalacia due to vitamin D depletion: a neglected consequence of intestinal malabsorption.&#8221;<\/strong>\u00a0This study investigating the belief that vitamin D depletion is rare in the United States because of the routine fortification of milk and other dairy products with vitamin D shows that osteomalacia due to vitamin D depletion appears not to be suspected or diagnosed promptly in susceptible patients, perhaps because their physicians were not sufficiently aware of this condition. Researchers present a series of patients with histologically verified osteomalacia due to vitamin D depletion to emphasize the need for more careful and systematic surveillance of patients at risk of this metabolic bone disease.<\/p>\n<p style=\"text-align: justify\">Between 1989 and 1994, 17 patients with osteomalacia due to vitamin D depletion were seen in the Bone and Mineral Division of Henry Ford Health System, Detroit. All patients had a transiliac bone biopsy after in vivo double tetracycline labeling. Biochemical indexes of vitamin D nutritional status, parathyroid function, markers of bone turnover, and bone mineral density were assessed at the time of bone biopsy. The duration of symptoms, the lag between the cause of vitamin D depletion and the development of symptoms, and the x-ray findings were recorded. Osteomalacia was suspected by the referring physician in only 4 of the 17 patients, although a gastrointestinal disorder that can lead to vitamin D depletion was present in every patient. Thirteen of the patients had sustained at least one osteoporotic fracture (wrist, spine, or hip), and most had low appendicular and axial bone mineral density. All patients had one or more biochemical abnormalities consistent with vitamin D depletion. In 4 patients, a progressive rise in the serum alkaline phosphatase level was recorded but was not investigated until the patient presented with bone pain, muscle weakness, or fracture.<a href=\"#footnote_12_776\" id=\"identifier_19_776\" class=\"footnote-link footnote-identifier-link\" title=\"Basha B, Rao DS, Han ZH, Parfitt AM. Osteomalacia due to vitamin D depletion: a neglected consequence of intestinal malabsorption. Am J Med. 2000 Mar;108(4):296-300.\">12<\/a><\/p>\n<h4 style=\"text-align: justify\"><strong>CASE REPORT SUMMARIES<\/strong><\/h4>\n<p style=\"text-align: justify\"><strong>&#8220;Bone pain and extremely low bone mineral density due to severe vitamin D deficiency in celiac disease<\/strong>.&#8221;\u00a0This case study describes finding a non-detectible vitamin D blood level in a 29-year-old wheelchair-bound woman who had lived in the Netherlands all her life and was born of Moroccan parents. Her medical history revealed iron deficiency, growth retardation, and celiac disease, for which she was put on a gluten-free diet but did not follow.<\/p>\n<p style=\"text-align: justify\">She had progressive bone pain for 2 years, difficulty with walking, and about 15 kg weight loss. She had a short stature, scoliosis (curvature), and pronounced kyphosis of the spine with thoracic and lumbar percussion pain (pain on tapping). Pelvis and shoulders also were painful on touching. There was muscle atrophy and symmetrical loss of proximal muscle strength. She was short of breath during normal daily activities and poor condition of her teeth. She had a regular menstrual cycle, and her menarche was at 17 years of age. She had neither abdominal complaints nor diarrhea. On physical examination, she was pale. Her body height was 148 cm (previously 156 cm) and her weight, 38 kg.<\/p>\n<p style=\"text-align: justify\">Laboratory results showed hypocalcemia, an immeasurable serum 25-hydroxyvitamin D level, and elevated parathyroid hormone and alkaline phosphatase levels. Spinal rx-rays showed unsharp, low contrast vertebrae. Bone mineral density (bone scan) measurement at the lumbar spine and hip showed a T-score of -6.0 and -6.5, respectively. A bone scintigraphy showed multiple hotspots in ribs, sternum, mandible, and long bones. A bone biopsy showed severe osteomalacia but normal bone volume. A duodenal biopsy revealed villous atrophy (Marsh 3C) and positive antibodies against endomysium, transglutaminase, and gliadin, compatible with active celiac disease She was treated with calcium intravenously and later orally. Furthermore, she was treated with high oral doses of vitamin D and a gluten-free diet. After a few weeks of treatment, her bone pain decreased, and her muscle strength improved.<a href=\"#footnote_6_776\" id=\"identifier_20_776\" class=\"footnote-link footnote-identifier-link\" title=\"Rabelink NM, Westgeest HM, Bravenboer N, Jacobs MA, Lips P. Bone pain and extremely low bone mineral density due to severe vitamin D deficiency in celiac disease.&nbsp;Arch Osteoporos. 2011 Dec;6(1-2):209-13. doi: 10.1007\/s11657-011-0059-7.\">6<\/a><\/p>\n<p style=\"text-align: justify\"><strong>&#8220;Celiac disease causing symptomatic hypocalcaemia, osteomalacia and coagulapathy.&#8221;<\/strong> This case report describes diagnosing celiac disease in a 36-year-old gentleman who presented with 6 months of poor energy, tingling in fingers and weight loss with a change in bowel habit. He appeared cachectic and had clubbing, demineralisation of teeth, pectus carinatus, kyphosis, spinal tenderness, proximal muscle weakness and generalised muscle wasting (atrophy).<\/p>\n<p style=\"text-align: justify\">Chvostek&#8217;s and Trosseau&#8217;s signs were positive. His hemoglobin (Hb) was 8.7 g\/dl, MCV 64.7 fl with low iron. Calcium corrected was 1.30 nmol\/l, parathyroid hormone 440.4 ng\/l, vitamin D &lt;12.5 nmol\/l; INR was 2.7 with coagulation inhibitor studies negative. Radiographs of spine and pelvis commented on osteopenia with thoracic kyphosis and mild anterior wedging of thoracic vertebrae. Antitissue transglutaminase was 145 U\/ml, and antiendomysial antibodies were positive. An esophagogastroduodenoscopy was consistent with celiac disease. A diagnosis of osteomalacia and coagulopathy secondary to celiac disease was made.<\/p>\n<p style=\"text-align: justify\">The hypocalcaemia was treated with calcium gluconate infusions with symptomatic relief. Coagulopathy was treated with vitamin K intravenously with normalization of INR (international normalised ratio), a lab measurement to determine coagulation.<a href=\"#footnote_13_776\" id=\"identifier_21_776\" class=\"footnote-link footnote-identifier-link\" title=\"McNicholas BA, Bell M. Coeliac disease causing symptomatic hypocalcaemia, osteomalacia and coagulapathy. BMJ Case Rep. 2010 Dec 1;2010. pii: bcr0920092262. doi: 10.1136\/bcr.09.2009.2262.\">13<\/a><\/p>\n<p style=\"text-align: justify\"><strong>&#8220;Disabling osteomalacic myopathy as the only presenting feature of celiac disease.&#8221;<\/strong>\u00a0This case report describes diagnosing celiac disease in a 59-year-old woman who presented with a 3-month history of bilateral, proximal lower-limb weakness associated with disabling pain that rendered her wheelchair-bound. There were no gastrointestinal symptoms. Clinical examination showed evidence of bilateral, proximal muscle atrophy and weakness in the lower limbs. Low serum calcium and raised serum alkaline phosphatase, coupled with radiological findings, led to the diagnosis of osteomalacia. Subsequent gastroscopy and duodenal biopsy confirmed a diagnosis of coeliac disease. With adherence to a gluten-free diet, the patient&#8217;s condition remarkably improved within 3 months and she could walk pain-free using a stick. Osteomalacia and myopathy may rarely be the initial and primary presentations of coeliac disease. There are very few reports of osteomalacia as the only presentation of coeliac disease and no reports that describe such a dramatic recovery 3 months after commencing a gluten-free diet. A review of the literature regarding osteomalacia and myopathy in coeliac disease is presented.<a href=\"#footnote_14_776\" id=\"identifier_22_776\" class=\"footnote-link footnote-identifier-link\" title=\"Byrne MF, Razak AR, Leader MB, Sheehan KM, Patchett SE. Disabling osteomalacic myopathy as the only presenting feature of coeliac disease. Eur J Gastroenterol Hepatol. 2002 Nov;14(11):1271-4.\">14<\/a><\/p>\n<p style=\"text-align: justify\">\n<ol class=\"footnotes\"><li id=\"footnote_1_776\" class=\"footnote\">Mittal R, Kalra P, Dharmalingam M. Vitamin D deficiency presenting like hypophosphatemic osteomalacia. <em>Indian J Endocrinol Metab<\/em>. 2012 Dec;16(Suppl 2):S413-5. doi: 10.4103\/2230-8210.104112.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_1_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_5_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_2_776\" class=\"footnote\">Arnala I, Kemppainen T, Kroger H, Janatuinen E, Alhava EM. Bone histomorphology in celiac disease. <em>Annales Chirurgiae Et Gynaecologiae.<\/em> 2001;90(2):100-4.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_2_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_3_776\" class=\"footnote\">Philip R, Patidar P, Saran S, Agarwal P, Gupta K. <em>Endocrine manifestations of celiac disease<\/em>. <em>Indian J Endocrinol Metab<\/em>. 2012 December; 16(Suppl 2): S506\u2013S508.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_3_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_4_776\" class=\"footnote\">Chakravarthi SD, Jain K, Kochhar R, Bhadada SK, Khandelwal N, Bhansali A, Dutta U, Nain CK, Singh K. Prevalence and predictors of abnormal bone mineral metabolism in recently diagnosed adult celiac patients.\u00a0<em>Indian J Gastroenterol.<\/em>\u00a02012 Jul;31(4):165-70. Epub 2012 Aug 11.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_4_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_5_776\" class=\"footnote\">Arnala I, Kemppainen T, Kroger H, Janatuinen E, Alhava EM. Bone histomorphology in celiac disease. <em>Annales Chirurgiae Et Gynaecologiae<\/em>. 2001;90(2):100-4.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_6_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_18_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_6_776\" class=\"footnote\">Rabelink NM, Westgeest HM, Bravenboer N, Jacobs MA, Lips P. Bone pain and extremely low bone mineral density due to severe vitamin D deficiency in celiac disease.\u00a0<em>Arch Osteoporos<\/em>. 2011 Dec;6(1-2):209-13. doi: 10.1007\/s11657-011-0059-7.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_7_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_20_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_7_776\" class=\"footnote\">Byrne MF, Razak AR, Leader MB, Sheehan KM, Patchett SE. Disabling osteomalacic myopathy as the only presenting feature of coeliac disease.\u00a0<em>Eur J Gastroenterol Hepatol<\/em>. 2002 Nov;14(11):1271-4.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_8_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_8_776\" class=\"footnote\">Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.\u00a0<em>Clinical Science<\/em>. Apr 2001;100(4):379-86.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_9_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_9_776\" class=\"footnote\">Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.\u00a0<em>Journal of Gastroenterology and Hepatology<\/em>. 2003;18:479-91.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_10_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_11_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_12_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_13_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_14_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_15_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_10_776\" class=\"footnote\">Chakravarthi SD, Jain K, Kochhar R, Bhadada SK, Khandelwal N, Bhansali A, Dutta U, Nain CK, Singh K. Prevalence and predictors of abnormal bone mineral metabolism in recently diagnosed adult celiac patients.\u00a0<em>Indian J Gastroenterol.<\/em>\u00a02012 Jul;31(4):165-70.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_16_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_11_776\" class=\"footnote\">Philip R, Patidar P, Saran S, Agarwal P, Gupta K. Endocrine manifestations of celiac disease.\u00a0<em>Indian J Endocrinol Metab<\/em>. 2012 December; 16(Suppl 2): S506\u2013S508.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_17_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_12_776\" class=\"footnote\">Basha B, Rao DS, Han ZH, Parfitt AM. Osteomalacia due to vitamin D depletion: a neglected consequence of intestinal malabsorption. <i>Am J Med. <\/i>2000 Mar;108(4):296-300.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_19_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_13_776\" class=\"footnote\">McNicholas BA, Bell M. Coeliac disease causing symptomatic hypocalcaemia, osteomalacia and coagulapathy. <em>BMJ Case Rep<\/em>. 2010 Dec 1;2010. pii: bcr0920092262. doi: 10.1136\/bcr.09.2009.2262.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_21_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_14_776\" class=\"footnote\">Byrne MF, Razak AR, Leader MB, Sheehan KM, Patchett SE. Disabling osteomalacic myopathy as the only presenting feature of coeliac disease. <em>Eur J Gastroenterol Hepatol<\/em>. 2002 Nov;14(11):1271-4.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_22_776\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>What Is Osteomalacia? Osteomalacia is a metabolic bone disorder\u00a0that causes abnormal skeletal changes\u00a0characterized by generalized reduction in bone density (bone softening) in adults and pseudofractures (apparant on x-ray) with muscular weakness and bone tenderness. Bones have the normal amount of living collagen tissue that make up their structure but lack adequate calcium and phosphorus minerals &#8230;<\/p>\n","protected":false},"author":29,"featured_media":6910,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[4,213,102,783,1682,191,118,236,51,111],"tags":[1309,1308,1311,1968,116,780,1318,1312,776,317,318,330,1317,1316,1313,1315,1319,1889,1314,1908],"class_list":["post-776","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-conditions-2","category-bones","category-calcium","category-complications-health-conditions-2","category-malabsorption-disorders","category-muscles","category-phosphorus","category-spine","category-skeletal-2","category-vitamin-d","tag-achy-hips","tag-achy-knees","tag-achy-spine","tag-bones","tag-complications","tag-elevated-bone-alkaline-phosphatase-balp","tag-elevated-parathyroid-hormone-pth","tag-feet-hurt","tag-health-conditions","tag-hypocalcemia","tag-hypophosphatemia","tag-osteomalacia","tag-pelvis-pain","tag-poor-appetite","tag-ribs-hurt","tag-sleep-problem","tag-soft-bones","tag-skeletal-2","tag-tender-bones","tag-vitamin-d"],"_links":{"self":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/776","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/users\/29"}],"replies":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/comments?post=776"}],"version-history":[{"count":38,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/776\/revisions"}],"predecessor-version":[{"id":15439,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/776\/revisions\/15439"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media\/6910"}],"wp:attachment":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media?parent=776"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/categories?post=776"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/tags?post=776"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}