Thursday, December 07, 2006

Osteoporosis? Get screened for celiac disease.

I frequently encounter younger and younger women as well as more men who have been diagnosed as having osteoporosis or osteopenia. Osteoporosis is a progressive decline in bone density. The bones are weakened and the brittleness predisposes to fractures from even minor falls or trauma. Sometimes, even opening a window, lifting or being hugged can result in spine fractures. Bone density normally declines with age, especially in women who undergo menopause who are not receiving estrogen supplementation. However, accelerated osteoporosis occurs from poor absorption of calcium such as when the gut is damaged or injured. In pre-menopausal women Celiac disease is a common yet often unrecognized cause of osteoporosis from gut injury resulting in malabsorption.

Often I see patients for routine screening colonoscopy at age 50 and I note that they are on fosamax or other medications for osteoporosis. Many also list thyroid hormone medication. When I inquire about these medications, they don't seem to think it is that unusual, just part of getting older, Yet, on further questioning, most admit to chronic gastrointestinal symptoms like bloating, gas, and diarrhea, usually resulting in a diagnosis of irritable bowel syndrome. Few of them have ever been screened for celiac disease. Why is this? Most physicians and certainly most patients are unaware of the associations of hypothyroidism, irritable bowel syndrome or osteoporosis with celiac disease. A survey of primary care physicians published in 2005 confirmed that less than half (45%) were aware that osteoporosis was a manifestation of celiac disease. Only 13% were aware of the association of diabetes with celiac and less than a third knew symptoms of celiac could begin in adulthood. It is no wonder that though 1/100 in people have celiac disease, the majority remain undiagnosed and suffer for an average of 13 years before diagnosis, usually too late to fully reverse a variety of associated autoimmune, musculoskeletal, and neurologic conditions.

Amagan and colleagues published in 2005 results of screening of almost 100 pre-menopausal women with idiopathic osteoporosis. They found 10-20% had blood tests positive for Celiac disease or gluten sensitivity. Since 1% of people have Celiac disease, most undiagnosed, a ten to twenty times incidence of Celiac disease in individuals with osteoporosis is observed. This justifies the recommendation that all women who have unexplained osteoporosis and all pre-menopausal women with premature osteoporosis should be screened for Celiac disease.

If you are a man or a woman under 50 with osteopenia or osteoporosis, I recommend you ask your doctor to screen you for celiac disease. If you have any gastrointestinal symptoms, fatigue, history of infertility, type I diabetes, thyroid disorder, rheumatoid arthritis, headaches, neuropathy, anemia, or skin problems you should also be screened.

Amagan O Clin Rheumatol. 2005 (3):239-43
Zipser, J Gen Intern Med. 2005; 20(7):644-46.

Osteoporosis Resource:
National Osteoporosis Foundation

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