starts to exceed bone replacement after the age of 35. For patients with CD the most important factor in minimising the risk of
osteoporosis is adhering to a GFD. The role of lifestyle factors should not be underestimated and patients should be given general advice about exercise (particularly weight bearing), smoking, alcohol excess, and adequate dietary calcium. For adults with CD a total daily
calcium intake of 1500mg should be ensured. If dietary calcium is inadequate, malabsorption is suspected or patients present with low serum calcium levels, 500-1000mg supplemental calcium should be given. A low normal calcium and an elevated PTH indicate secondary hyperparathyroidism and treatment with calcium (800 mg) together with Vitamin D (400-800 units) should be given. Dairy products should be incorporated into the diet to provide prime sources of calcium. At least 4 servings of dairy foods (i.e. milk, yoghurt, and cheese) are needed to meet the daily calcium requirement. Where milk-allergy or lactose intolerance is present patients may obtain calcium from the following non-dairy sources: Calcium-enriched milk alternatives such as soya milk, fish with edible bones i.e. salmon and sardines, tofu, baked beans, dried figs.
The treatment of osteoporosis
A gluten-free diet is considered the first-choice therapy in CD children, because it appears to lead to the recovery of a normal level of
bone mass. There is a lack of prospective studies with long-term follow-up and there is still no evidence that bone mass can be maintained thereafter as in normal subjects. There are no systematic data concerning the efficacy of the drugs commonly used for
osteoporosis in patients with CD. The management of low BMD and CD has been outlined by Scot et al and apart from a GFD, people with CD should follow conventional lines, including:
- Adequate dietary calcium i.e. 1500 mg; using supplementation if necessary
- Regular weight bearing exercise
- Cessation of smoking and avoidance of excess alcohol
- Drugs, including hormone replacement therapy, bisphosphonates, and calcitonin.
In cases where a diagnosis has been made or if the GFD is ineffective at promoting remineralisation, additional secondary causes of
osteoporosis should be ruled out - these causes include: corticosteroids untreated hypogonadism, thyroid dysfunction, hyperprolactinemia, medications (anticonvulsants). With courtesy of Coeliac UK
