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Osteoporosis

Woman with long standing osteoporosis. Courtesy of Wikimedia.
Woman with long standing osteoporosis. Courtesy of Wikimedia.

What Is Osteoporosis?

[dropcap]O[/dropcap]steoporosis is a metabolic bone disorder characterized by diminished bone mass (density) with normal cell appearance but fragile bone strength that prediposes to broken bones, and with high bone turnover.

This condition usually goes undetected until late when loss of height or a bone fracture occurs. In fact, each year  1.5 million fractures mainly of the hip, spine and wrist are attributed to osteoporosis. Compression fractures of vertebrae bones are the most common, accounting for 700,000 cases.

Bone is composed of specialized connective tissue called osseous tissue. Osseous tissue is made up of living bone cells (osteocytes) that are embedded in a hard matrix (framework) of calcified substance.

Bone matrix contains collagen fibers and the minerals calcium phosphate and calcium carbonate, which provide strength to bone. The copper enzyme, lysyl oxidase, is involved in the cross-linking of collagen in forming the framework for depositing calcium and other minerals to build and repair bone.

Q: How do osteocytes function in bone?

A: Osteocytes maintain the health of bone by their metabolic activity in regulating normal bone turnover. Bone turnover is the breaking down and removal of old or damaged bone and rebuilding or remodeling of healthy bone that is ongoing throughout life. The bone formation process takes about 3 months to complete.

Osteoporosis develops from failure of the body to maintain health and to provide bone tissue with adequate nutrition for proper function. Risk factors that can be modified include: low calcium intake, sedentary lifestyle, smoking, drinking alcohol excessively, eating a diet with excessive caffeine, protein, and phosphate, and taking certain medications over a long time such as steroids, thyroid preparations, the anti-convulsive drug phenytoin, aspirin, antacids, anticoagulants, some diuretics, and some chemotherapeutic drugs. See below for a fuller description.

In addition to celiac disease, osteoporosis is associated with advancing age, family history, nulliparity (no pregnancies) and post-menopause in females, certain disorders such as hyperthyroidism, hypogonadism, inflammatory bowel disease like Crohn’s disease, multiple myeloma, anorexia nervosa, and Cushing’s disease.

Bone strength is easily measured by testing bone mineral density (BMD). BMD is evaluated by DEXA scan (dual-energy X-ray absorptiometry).  DEXA at the femoral neck and lumbar spine is considered the gold standard to confirm the diagnosis of osteoporosis.  Results are expressed as T and Z scores. T scores compare the result with a 20 to 40 year old helathy person while  Z scores compare the result with persons in the same age group. Both are measured in standard deviations (SD).

According to WHO criteria (World Health Organization), a T-score of -1 SD or greater denotes normal bone, a T-score between −1 to −2.5 SD denotes osteopenia, and a T-score of −2.5 or more denotes osteoporosis.1

Treatment is aimed to preserve and increase bone density, minimize symptoms for better quality of life and reduce risk of bone fractures.

What Is Osteoporosis In Celiac Disease and/or Gluten Sensitivity?

The cumulative effects of gluten-induced inflammation, treatment delay, and malabsorption result in lower bone density and bone fragility.2

Sources:
  1. Pantaleoni S, Luchino M, Adriani A, Pellicano R, Stradella D, Ribaldone DG, Sapone N, Isaia GC, Di Stefano M, Astegiano M. Bone mineral density at diagnosis of celiac disease and after 1 year of gluten-free diet. ScientificWorldJournal. 2014;2014:173082. doi: 10.1155/2014/173082. [↩]
  2. Grace-Farfaglia P. Bones of Contention: Bone Mineral Density Recovery in Celiac Disease-A Systematic Review. Nutrients. 2015 May 7;7(5):3347-3369. [↩]

Rickets

Rickets in a young child. Courtesy of Wikipedia
Rickets With Characteristic Bowed Legs In A Young Child. Courtesy of Wikipedia

What Is Rickets?

[dropcap]R[/dropcap]ickets is a disorder of cartilage cell growth and enlargement of epiphyseal growth plates in young children that is characterized by inadequate mineralization of developing cartilage and newly formed bone.

The epiphyseal growth plate is located at the ends of the long bones of the arms and legs and controls the growth of these bones. Enlargement of the plate area gives the physical appearance of thick joints at the wrists, knees, and ankles.

Q: What is inadequate mineralization of bone tissue?

A: Inadequate mineralization means there is not sufficient calcium, magnesium, phosphorus and other minerals available to give bone that is replacing cartilage in a young child its necessary strength during the period of enchondral bone formation. Consequently, long bones bend under the weight of the body and become deformed.

Children 4 to 18 months of age worldwide are at risk of developing rickets.

What Is Rickets In Celiac Disease and/or Gluten Sensitivity?

Short Stature

Short StatureWhat Is Short Stature?

[dropcap]S[/dropcap]hort stature means the individual has not reached a normal height as a result of failure to thrive and severe growth delay in children.1

What Is Short Stature In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Catassi C, Fasano A. Celiac disease as a cause of growth retardation in childhood. OpinionCurrent  in Pediatrics. Aug 2004;16(4):445-9. [↩]

Osteopenia In Childhood 

Ultrasound scanner is safe for determininfg bone density in children. Courtesy rah.sa.gov.au
Ultrasound scanner tests bone density in children. Courtesy rah.sa.gov.au

What Is Osteopenia In Childhood?

[dropcap]O[/dropcap]steopenia is a metabolic bone disorder characterized by diminished bone mass with the retention of normal cell appearance and high bone turnover.

That is, bone production does not keep up with bone loss. Bones looks normal on the outside but are thin on the inside, making them more susceptible to easy fractures.

Q: How is osteopenia diagnosed?

A: Bone mineral density (BMD) testing is required for diagnosis of osteopenia.

What Is Osteopenia In Childhood In Celiac Disease and/or Gluten Sensitivity?

Bone Pain

Chiropracter Adjusting Spine for Back Pain.
Chiropractor Adjusting Spine for Back Pain.

What Is Bone Pain?

[dropcap]B[/dropcap]one pain is pain or tenderness in bone tissue. Bone pain intensity and location depend on the causative disorder.

Q: What are causative disorders of bone pain?

A: Bone pain is a feature of various disorders that include malnutrition, bone disease such as osteoarthritis, infection, inflammation, hyperparathyroidism, immune mechanisms, fractures, adverse effects or toxic effects of certain medications, and cancer such as sarcoma, leukemia, multiple myeloma, and metastatic lesions from a primary tumor elsewhere.

What Is Bone Pain In Celiac Disease and/or Gluten Sensitivity?

Osteitis Fibrosa Cystica 

X-ray showing osteitis fibrosa cystica in long bones. Courtesy Wikimedia.
X-ray showing osteitis fibrosa cystica in long bones. Courtesy Wikimedia.

What Is Osteitis Fibrosa Cystica?

[dropcap]O[/dropcap]steitis fibrosa cystica is a metabolic bone disease characterized by decalcification and softening of bones with bone cyst formation and bone tumors developing from effects of chronic vitamin D deficiency causing hyperparathyroidism and parathyroid adenoma (tumor).

Hyperparathyroidism is a sustained elevated parathyroid hormone level in the blood which draws calcium from bone tissue.

Q: How does vitamin D deficiency cause hyperparathyroidism?

A: Vitamin D is required to absorb calcium from the food we eat. Deficiency of vitamin D  in turn causes deficiency of calcium to develop. Without adequate calcium for essential body functions, the pituitary gland stimulates the parathyroid glands to produce parathyroid hormone for the purpose of getting calcium from bone tissue which is less essential to life.

Unfortunately, the bones become depleted of calcium and become soft and disfigured.

What Is Osteitis Fibrosa Cystica In Celiac Disease and/or Gluten Sensitivity?

Osteomalacia

The woman's legs second from the right show bowing in osteomalacia.
The legs second from the right show bowing in osteomalacia in contrast to the others.

What Is Osteomalacia?

[dropcap]O[/dropcap]steomalacia is a metabolic bone disorder that causes abnormal skeletal changes characterized 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 that are required for strength.

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.

Q: How do bones get soft?

A: 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.

In the condition of osteomalacia, there is not adequate 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.

The main causes of vitamin D deficiency include malabsorption, poor diet, lack of sunshine, and disorders of vitamin D metabolism. 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.

What Is Osteomalacia In Celiac Disease and/or Gluten Sensitivity?

Osteonecrosis

X-ray showing osteonecrosis of the femur. Courtesy Wikimedia.
X-ray showing osteonecrosis of the femur (right side). Courtesy Wikimedia.

What Is Osteonecrosis?

[dropcap]O[/dropcap]steonecrosis is a bone disorder resulting from insufficient blood flow to a part of the skeleton and is characterized by resulting death of bone cells (necrosis).

After a while the bone can collapse. If this condition is not treated, the joint will deteriorate and this will become severe arthritis.

It is most common in the hip and shoulder, but can affect other large joints such as knee, elbow, wrist and ankle.1

What Is Osteonecrosis In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004519/ [↩]