Celiac Disease Testing May Help Osteoporosis
Screening for Wheat Intolerance May Aid in Osteoporosis Treatment
Feb. 28, 2005 - Screening people with osteoporosis for a condition that makes it difficult to digest wheat may help improve treatment and reduce the risks associated with the common bone-weakening disease.
A new study shows that celiac disease, a disorder of the immune system that damages the small intestine when foods containing gluten are eaten, is much more common among people with osteoporosis. Gluten is a form of protein found in grains such as wheat, barley, and rye.
Researchers say the results show that a higher prevalence of celiac disease in people with osteoporosis may justify screening for the disorder among all individuals with osteoporosis, and putting those with both conditions on a gluten-free diet may help reduce the risk of fractures.
Weak Bones Linked to Celiac Disease
Participating in the study were 266 mostly white postmenopausal women with osteoporosis and 554 women without osteoporosis. The researchers used blood tests to screen for the presence of antibodies associated with celiac disease. Women with a positive antibody test then underwent an intestinal biopsy to confirm the diagnosis.
Women with celiac disease were treated with a gluten-free diet and followed up for improvement in bone mineral density -- a measure of bone strength used to determine fracture risk.
Researchers found that nearly 4.5% (12) of the osteoporosis patients tested positive for celiac disease compared with only 1.0 % (six) of the women without osteoporosis.
Biopsy-proven celiac disease was confirmed in 3.4% of women with osteoporosis and only 0.2% of women without osteoporosis.
In addition, researchers found that more severe celiac disease was associated with more severe osteoporosis.
The study showed that treating individuals with osteoporosis and celiac disease with a gluten-free diet for one year improved their bone mineral density (BMD).
"The improvement in BMD for celiac disease patients on the gluten-free diet was greater than that expected for osteoporotic patients receiving standard therapy," writes researcher William F. Stenson, MD, of Washington University School of Medicine in St. Louis, and colleagues.
In an editorial that accompanies the study, Alan L. Buchman, MD, MSPH, of the Feinberg School of Medicine at Northwestern University, says the results of the study raise an important issue but it's too soon to recommend widespread screening for celiac disease among osteoporosis patients.
Researchers estimate that screening the 10 million people in the U.S. with osteoporosis for celiac disease would cost about $2 billion. They estimate that the cost to prevent a single broken bone in a person with celiac disease and osteoporosis would be $43,000, but the cost would be far greater if screening were extended to the nearly 18 million Americans with low bone mass (osteopenia) who are at risk for osteoporosis.
Given the variations in cost and benefit estimates, Buchman says "it is impossible to make a clear recommendation for CD screening in a population even as defined as those with osteoporosis. As is often the case, further study is needed."