Search tips
Search criteria 


Logo of gutGutView this articleSubmit a manuscriptReceive email alertsContact usBMJ
Gut. 1995 May; 36(5): 710–714.
PMCID: PMC1382674

Osteoporosis in treated adult coeliac disease.


Forty five women and 10 men with coeliac disease diagnosed in adult life, who were already on a gluten free diet, had serial bone mineral density measurements at the lumbar spine and femoral neck over 12 months. Osteoporosis, defined as a bone mineral density (BMD) < or = 2 SD below the normal peak bone mass was found in 50% of male and 47% of female coeliac patients. Patients with a BMD < or = 2 SD below age and sex matched normal subjects, had a significantly lower body mass index (21.3 kg.m-2 compared with 25.2 kg.m-2, p < 0.02 Wilcoxon rank sum test) and lower average daily calcium intake (860 mg/day compared with 1054 mg/day, p < 0.05 Wilcoxon rank sum test) than patients with normal bone mineral density. In postmenopausal women with coeliac disease there was a strong correlation between the age at menopause and BMD at both the lumbar spine (r = 0.681, p < 0.01, Spearman's rank correlation) and femoral neck (r = 0.632, p < 0.01). No overall loss of bone was shown over the 12 months of follow up, and relative to the reference population there was a significant improvement in BMD at the lumbar spine in women (p < 0.025, paired t test) and at the femoral neck in men (p < 0.05, paired t test). There was a significant negative correlation between the annual percentage change in BMD at the lumbar spine and the duration of gluten free diet (r = -0.429, p<0.01, Spearman's rank correlation), with the largest gain in BMD in patients with most recently diagnosed coeliac disease. Osteoporosis was shown in 47% of patients with treated adult coeliac disease. Recognised risk factors for osteoporosis in the general population including low body mass index, dietary calcium intake, and early menopause are particularly important in coeliac disease. Treatment of coeliac disease with a gluten free diet probably protects against further bone loss, and in the early stages is associated with a gain in bone mineral density.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (926K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • JUERGENS JL, SCHOLZ DA, WOLLAEGER EE. Severe osteomalacia associated with occult steatorrhea due to nontropical sprue; report of five cases. AMA Arch Intern Med. 1956 Dec;98(6):774–782. [PubMed]
  • De Boer WA, Tytgat GN. A patient with osteomalacia as single presenting symptom of gluten-sensitive enteropathy. J Intern Med. 1992 Jul;232(1):81–85. [PubMed]
  • Melvin KE, Hepner GW, Bordier P, Neale G, Joplin GF. Calcium metabolism and bone pathology in adult coeliac disease. Q J Med. 1970 Jan;39(153):83–113. [PubMed]
  • Bodé S, Hassager C, Gudmand-Høyer E, Christiansen C. Body composition and calcium metabolism in adult treated coeliac disease. Gut. 1991 Nov;32(11):1342–1345. [PMC free article] [PubMed]
  • Lindh E, Ljunghall S, Larsson K, Lavö B. Screening for antibodies against gliadin in patients with osteoporosis. J Intern Med. 1992 Apr;231(4):403–406. [PubMed]
  • Logan RF, Tucker G, Rifkind EA, Heading RC, Ferguson A. Changes in clinical features of coeliac disease in adults in Edinburgh and the Lothians 1960-79. Br Med J (Clin Res Ed) 1983 Jan 8;286(6359):95–97. [PMC free article] [PubMed]
  • Corazza GR, Frisoni M, Treggiari EA, Valentini RA, Filipponi C, Volta U, Gasbarrini G. Subclinical celiac sprue. Increasing occurrence and clues to its diagnosis. J Clin Gastroenterol. 1993 Jan;16(1):16–21. [PubMed]
  • Molteni N, Caraceni MP, Bardella MT, Ortolani S, Gandolini GG, Bianchi P. Bone mineral density in adult celiac patients and the effect of gluten-free diet from childhood. Am J Gastroenterol. 1990 Jan;85(1):51–53. [PubMed]
  • Caraceni MP, Molteni N, Bardella MT, Ortolani S, Nogara A, Bianchi PA. Bone and mineral metabolism in adult celiac disease. Am J Gastroenterol. 1988 Mar;83(3):274–277. [PubMed]
  • Slemenda CW, Hui SL, Longcope C, Wellman H, Johnston CC., Jr Predictors of bone mass in perimenopausal women. A prospective study of clinical data using photon absorptiometry. Ann Intern Med. 1990 Jan 15;112(2):96–101. [PubMed]
  • Falch JA, Sandvik L, Van Beresteijn EC. Development and evaluation of an index to predict early postmenopausal bone loss. Bone. 1992;13(4):337–341. [PubMed]
  • Reginster JY, Denis D, Deroisy R, Albert A, Sarlet N, Collette J, Franchimont P. Dual photon absorptiometry of lumbar spine in west European (Belgian) postmenopausal females: normal range and fracture threshold. Clin Rheumatol. 1990 Jun;9(2):220–224. [PubMed]
  • Nordin BE. The definition and diagnosis of osteoporosis. Calcif Tissue Int. 1987 Feb;40(2):57–58. [PubMed]
  • Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet. 1993 Jan 9;341(8837):72–75. [PubMed]
  • Boyce BF. Uses and limitations of bone biopsy in management of metabolic bone disease. Baillieres Clin Endocrinol Metab. 1988 Feb;2(1):31–57. [PubMed]
  • Theintz G, Buchs B, Rizzoli R, Slosman D, Clavien H, Sizonenko PC, Bonjour JP. Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab. 1992 Oct;75(4):1060–1065. [PubMed]
  • Rico H, Revilla M, Hernandez ER, Villa LF, Lopez-Alonso A. Total and regional bone mineral content in normal premenopausal women. Clin Rheumatol. 1991 Dec;10(4):423–425. [PubMed]
  • Kröger H, Heikkinen J, Laitinen K, Kotaniemi A. Dual-energy X-ray absorptiometry in normal women: a cross-sectional study of 717 Finnish volunteers. Osteoporos Int. 1992 May;2(3):135–140. [PubMed]
  • Uebelhart D, Schlemmer A, Johansen JS, Gineyts E, Christiansen C, Delmas PD. Effect of menopause and hormone replacement therapy on the urinary excretion of pyridinium cross-links. J Clin Endocrinol Metab. 1991 Feb;72(2):367–373. [PubMed]
  • Toss G. Effect of calcium intake vs. other life-style factors on bone mass. J Intern Med. 1992 Feb;231(2):181–186. [PubMed]
  • Milsom S, Ibbertson K, Hannan S, Shaw D, Pybus J. Simple test of intestinal calcium absorption measured by stable strontium. Br Med J (Clin Res Ed) 1987 Jul 25;295(6592):231–234. [PMC free article] [PubMed]
  • Felson DT, Zhang Y, Hannan MT, Anderson JJ. Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res. 1993 May;8(5):567–573. [PubMed]

Articles from Gut are provided here courtesy of BMJ Group