Osteoporosis in gastrointestinal disorders: a discussion

Hello everyone,

Today I’ll discuss a serious topic that is: osteopenia and osteoporosis among patients with gastrointestinal diseases, focus on coeliac patients.

Celiac disease is an autoimmune disorder triggered by gluten consumption in genetically predisposed individuals that can cause gastrointestinal symptoms as well as affect bone health. Osteoporosis and low bone mineral density are common in individuals with celiac disease, and while malabsorption of minerals like Calcium (Ca2+) and vitamin D are potential causes, other factors related to the endocrine system may also play a role.

The development of osteoporosis in individuals with celiac disease is caused by various factors, and recent research has shed light on many of these mechanisms. As medicine moves towards a more personalized approach, emerging topics such as the gut microbiome and sex-related differences are becoming increasingly important.

Osteoporosis in celiac disease is caused by a complex interplay of different mechanisms. Bone is a constantly remodeling tissue, regulated by the actions of two types of cells called: osteoblasts (form bone tissue) and osteoclasts (bone to initiate normal bone remodeling). Hormones and nutrition also play a significant role in bone health, and these factors may be impaired in celiac disease. The process of bone loss begins in the third decade of life when bone resorption exceeds bone formation, leading to a gradual reduction in bone mass.

Malabsorption of calcium (Ca2+) in celiac disease is a significant factor in the development of bone demineralization. The damage to the villi in the proximal intestinal mucosa impairs Ca2+ absorption. A strict gluten-free diet (GFD) for at least 1-2 years is typically sufficient to normalize Ca2+ and vitamin D levels, but long-term supplementation may be necessary in certain cases, such as post-menopausal women. Nutritional counseling is essential to ensure adequate nutrient and micronutrient intake, and the introduction of fortified gluten-free foods or calcium supplementation may be necessary.

Interestingly, some studies indicate that patients with inflammatory diseases of the intestine, such as CD, Crohn’s disease, and enteropathies, generally have normal intestinal vitamin D absorption but are still deficient in vitamin D. However, some patients have normal levels of vitamin D in their blood despite having severely impaired intestinal vitamin D absorption. My own case is related to vitamin B12. Although my vili was destroyed when I was diagnosed, my Vit B12 was high and I never had issues with it (my main issue is iron and ferretin). I know so many coeliacs who have to take Vit B12 injections!

Osteopenia and osteoporosis are common in celiac disease, and strict adherence to gluten free diet is the most effective treatment. The role of gut microbiota in bone health is still uncertain, but probiotic supplementation may be a promising strategy. Physicians should be aware of bone conditions associated with celiac disease and provide a more targeted therapy in at-risk populations to ensure earlier diagnosis and management. Further studies are needed to assess the link between osteoporosis in celiac disease and sex-related differences.

Do you have osteopenia/osteoporosis? What’s your story? Share with us 🙂

Reference material:

Nutrients 2023, 15(5), 1089; https://doi.org/10.3390/nu15051089