Whenever I have a new celiac patient see me in my office, one of the first things I order  is a bone mineral density dexa scan.  Reason being, many of us have decreased bone density at the time of diagnosis due to the malabsorption of  nutrients from the food we were ingesting. Well, at least this is what I thought the reason was.  However, while scanning articles on celiac disease , I came across an article that stated in greater than 20% of the cases of osteoporosis in the face of celiac disease, the reason is other than malabsorption. The article is New Link Found Between Osteoporosis And Celiac Disease  in Science Daily October 8, 2009.

 In people without celiac disease, there is a protein called osteoprotegerin which plays a crucial role in maintaining bone health by controlling the rate at which bone tissue is removed. However, some patients with celiac disease  “produce antibodies that attack the OPG protein and stop it  from working properly. This results in rapid bone destruction and severe osteoporosis.” This type of osteoporosis responds poorly to just calcium and vitamin D supplementation. It’s only mode of treatment comes in the form of bisphophonates and other meds to treat osteoporosis.

Because there is no way to tell if a celiac patient’s decreased bone density is due to this “autoimmune”- type process versus a  malabsorptive- type process, erring on the side of caution should prevail and treatment with a medication should ensue with close monitoring of the response.

To read more from the article, go to http://www.sciencedaily.com/releases/2009/10/091007171735.htm.

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