Management of osteoporosis in people with coeliac disease

Bone mass measurement in patients with coeliac disease

There are doubts about the need to measure BMD in coeliacs, in addition, there are no clear guidelines on which patients should undergo bone mass measurement and when the first and subsequent measurements should be performed. In 1998 the British Society for Gastroenterology published its guidelines for osteoporosis in patients with CD, which recommended BMD measurement at diagnosis. A more recent paper by the same authors concluded that due to doubt about the increased fracture rates in coeliac patients, the current guidelines should be changed. A report by Corazza et al has suggested the following:

Children: There is evidence that very early treatment of CD in childhood prevents bone loss and most patients reach normal peak densitometric values. Consequently, there is no need to perform bone mass measurement in children if fully compliant with the gluten-free diet.

Adults: A report has suggested that in coeliacs diagnosed in adulthood, an approach based on clinical presentation should be followed.

Coeliac patients with overt malabsorption are potentially at a higher risk for osteoporosis and bone fractures, than asymptomatic coeliacs. Consequently, it has been suggested that in symptomatic patients BMD should be measured at diagnosis and after 2 years on a strict GFD. Only patients whose baseline BMD is below normal require a follow-up scan.

Asymptomatic patients may not require bone measurement at diagnosis, but instead BMD should be measured after the first year of strict adherence to a GFD. The decision to begin therapy with mineral-active drugs would thus be taken on the basis of dietary regimen efficacy.

In women, if the diagnosis is made earlier the BMD should be measured at the menopause. A single measurement at menopause may not be adequate because there is considerable variation in the rate and duration of rapid perimenopausal bone loss. Therefore, it is suggested to repeat the BMD after two years in those whose BMD does not suggest osteoporosis.

In men BMD should be measured at about 55 years of age if they presented at an earlier age.

How to minimise the risk

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