- The Connection Between Celiac Disease and Osteoporosis
People who have osteoporosis may need to be screened for celiac disease -- an intestinal disorder that is proving to be more common than previously thought. In a study reported in the Archives of Internal Medicine, researchers evaluated 840 people, 266 of whom had osteoporosis; 12 of them tested positive for celiac disease, vs. six of 574 people who didn’t have osteoporosis. Further study via endoscopic intestinal biopsies confirmed the presence of celiac disease in nine of the participants with osteoporosis and in one person who didn’t have osteoporosis.
Celiac disease is an intestinal disorder caused by intolerance to wheat gluten. Celiac disease was believed to be a rare disease in the United States. However, current estimates of its overall prevalence range from 5–15%, with prevalence rates higher in some selected populations. Celiac disease can contribute to gastrointestinal problems such as diarrhea. Celiac disease can also lead to malnutrition, because it interferes with absorption of essential nutrients, including iron and calcium. Treatment for celiac disease involves a gluten-free diet, which allows the intestine to heal. In this study, the researchers placed the 10 patients with celiac disease on a gluten-free diet; this led to an improvement in both their gastrointestinal symptoms and bone density levels.
- Should You Begin Drug Treatment for Osteopenia?
Is it a good idea to take the osteoporosis drug Fosamax (alendronate) if you have osteopenia but no other risk factors for fractures? The answer is no, according to the results of a cost-effectiveness study, reported in the Annals of Internal Medicine.
The question of when to begin osteoporosis treatment is a tricky one for women who have osteopenia (low bone mass) but don’t have osteoporosis or a history of fractures. Osteoporosis treatment is standard in women who have bone mineral density T-scores of –2.5 or greater, but not in women with T-scores higher than –2.5. Some organizations and researchers have recommended beginning osteoporosis treatment at T-scores of –2.0 or even –1.8, even without additional risk factors for fractures.
This study notes that the cost and risk of earlier osteoporosis treatment is warranted only if there is a reduction in the ultimate cost and disability that can be attributed to fractures. Overall, Fosamax is not cost-effective in osteopenic postmenopausal women who have not had any previous fractures, the study shows say, unless the woman is at risk independent of her bone mineral density readings. The results likely apply to Actonel (residronate) and Evista (raloxifene), according to the study, but can’t be applied to estrogen replacement therapy.
