Studies show that up to 60% of people with coeliac condition have reduced bone density and up to 35% have osteoporosis.1 There are a number of factors that contribute to the increased risk of osteoporosis in coeliac disease. On the one hand, the damage to the intestinal mucosa impairs the absorption of essential nutrients such as calcium and vitamin D, leading to a deficiency of these substances. On the other hand, chronic inflammatory processes promote the release of pro-inflammatory messengers such as tumour necrosis factor-α (TNF-α), interleukin-1 and interleukin-6, which disrupt bone formation.1 All of this can lead to secondary hyperparathyroidism and increased bone resorption, and in the long term, promote the development of osteopenia and osteoporosis.1
So much for the basic knowledge about bone density in celiac disease. A Polish research group examined a completely new aspect: they investigated the question of whether there is a connection between body composition and bone density in celiac patients. This topic is particularly relevant as the prevalence of overweight and obesity in people with CD is increasing, especially in Western countries. For example, a British study of 187 subjects with CD found that 44% were either overweight or obese.2
In the current study, 56 people with celiac disease were examined. Various body parameters such as BMI, muscle mass, fat-free body mass (consisting of muscles, bones and other fat-free tissues) and basal metabolic rate were measured, along with bone density in the lumbar spine and femoral neck. In addition, the serum levels of vitamin D and calcium were measured. The data collected were compared with the results of the control group.
The results show some interesting possible correlations: individuals with reduced bone mineral density were more likely to have:
One possible mechanism that could explain the correlation between low muscle mass and reduced bone mineral density is the reduced mechanical stress on the bones when muscle mass is low.1 Mechanical stimulation plays a crucial role in osteogenesis and is promoted by higher muscle mass. 1 This correlation shows that the treatment of patients with coeliac condition should not only include a change in diet, but also the integration of physical activity into the treatment regime.
It is also noteworthy that the study showed a clear correlation between a low BMI and a low body fat percentage and reduced bone density. Interestingly, however, there were no significant differences in body parameters between the celiac disease group and the control group.1
Finally, the researchers provide some useful tips that could help to promote bone health in people with coeliac disease: Adherence to a gluten-free diet is essential to improve bone density in coeliac patients and reduce the risk of fractures.1 At the same time, the researchers point out that the nutritional quality of coeliac patients often leaves something to be desired. This is because gluten-free products are often highly processed, which consequently means that important nutritional components are often missing.1 However, those affected should ensure that they eat a diet rich in fibre and polyphenols, as this can make a significant contribution to bone health.1 The gut microbiome plays an important role here: a high-quality diet supports the microflora in the gut, which is considered to be a potentially central factor for bone metabolism.1
Physical activity, especially resistance training, is important in addition to a healthy diet.1 This is because increasing lean body mass strengthens bone density and thus offers additional protection against bone disease.1