Osteoporosis and Coeliac Disease

What is Osteoporosis?

Osteoporosis is a condition in which the bones become fragile and brittle, leading to a higher risk of fracture than in normal bone. This occurs when bones lose minerals, such as calcium, leading to a loss of bone density. There are no obvious symptoms of osteoporosis until a fracture occurs. Consequently, a person will not know that they have osteoporosis unless it is diagnosed by clinical tests or if they have an osteoporotic fracture. Fractures in the spine are commonly missed as they may cause no or minimal symptoms. These are often picked up when X-rays are done for other reasons or by noticing a loss of height.

Bone density increases through childhood, teenage and young adult years, until peak bone density is reached. Bone is a dynamic substance which is continually being remodelled by bone formation and bone resorption. From the age of about 30, bones start to deteriorate in strength as bone resorption exceeds bone formation. This is a natural part of the ageing process. Women are at greater risk of developing osteoporosis than men. The hormone oestrogen is important for maintaining healthy bones, and when oestrogen levels suddenly decline after menopause, bone resorption occurs at a much faster rate resulting in a decrease in bone density and eventually osteoporosis. Although men lose bone strength at a more gradual rate, they are also at risk of developing osteoporosis. Other risk factors contributing to osteoporosis are certain medications, smoking, heavy alcohol consumption, a poor diet, a family history of osteoporosis, a lack of exercise, small stature and certain diseases (including coeliac disease).

What is an Osteoporotic Fracture?

A fracture simply means a broken bone. An osteoporotic fracture is a broken bone which occurs after minimal force. Any bone can be affected by osteoporosis, but the most common sites of osteoporotic fracture are bones in the ribs, wrist, spine, pelvis, upper arm and hip. Osteoporotic fractures are commonly caused by falling, coughing, sneezing and lifting.

Once a person has one osteoporotic fracture, the risk of them having future fractures rises significantly.

How is Osteoporosis Related to Coeliac Disease?

Inflammation of the small bowel lining in untreated coeliac disease causes malabsorption of nutrients including calcium. Calcium plays a vital role at a cellular level within the body’s tissues and fluids. This requires a stable blood level of calcium. If insufficient calcium is absorbed from the food we eat to maintain the required level of calcium in the blood, more is taken from the bones than can be replaced (increased bone resorption). This causes the bones to become weaker. If a child is malabsorbing calcium due to untreated coeliac disease, their bones may not form properly during the growing years.

How do I find out how strong my bones are?

Bone strength can be measured using a Dual-energy X-ray Absorptiometry (DXA) scan, commonly known as a bone density test. A small amount of X-ray is used to measure the density of your bones in the spine and hip. By comparing your bone density to an average young adult of the same gender, a ‘T-score’ is calculated. Your doctor can interpret your T-score to determine whether you have osteoporosis or whether you are at risk of developing osteoporosis. In children T-scores are not used as the child has not yet reached young adulthood. Instead the child’s bone density is compared to the average for their age and gender by using the ‘Z-score’.

How do I get a Bone Density Test?

Your GP or specialist can give you a referral to a hospital or a clinic, which perform bone density tests.

What about a Heel Ultrasound?

Heel Ultrasound is not the recommended standard test to measure your bone density and predict your risk of fracture. At present Heel Ultrasound is not covered by Medicare.

My doctor says that I am too young to worry about Osteoporosis

It is recommended that all adults diagnosed with coeliac disease should have a bone density test regardless of age, gender or menopausal status. Many people with coeliac disease have a low bone density when diagnosed. Although this may improve after the commencement of a gluten free diet, the improvement may not be enough to prevent problems from occurring later in life. In some people with coeliac disease, there is no improvement at all. Therefore, it is important to establish what your bone density is at the age you are now, so that steps can be taken to either improve, or maintain your bone density.

Does a Bone Density Measurement attract a Medicare Rebate?

A person medically diagnosed with coeliac disease is entitled to a Medicare rebate for a bone density measurement under item number 12315, “a proven malabsorptive disorder”. This rebate is available every two years. A number of other conditions, such as premature menopause, prednisone therapy or a previous fracture, also allow a bone density test under Medicare. A full list of eligible conditions is available from your doctor.

How often should I have a Bone Density Test done?

Usually no more frequently than every two years, unless recommended by your doctor. Where possible, it is important to have your bone density test repeated on the same bone densitometer at the clinic or hospital you attended for your initial visit. There can be slight differences in results obtained on different machines.

What is the Treatment for Osteoporosis?

An adequate calcium intake and weight bearing exercise are important. Additional treatments are often recommended. Specific medications are now available which have been shown to be very effective for the treatment of osteoporosis. Speak to your doctor about the different treatments for osteoporosis. Smoking and a high intake of alcohol should be avoided.

How much Calcium should I have?

Different amounts of calcium are needed throughout a person’s life, depending on their gender, menopausal status and age. In women, it also changes if you are pregnant or breastfeeding. Your doctor or dietitian can advise you on your requirements.

I am Lactose Intolerant – how do I get enough Calcium?

People with lactose intolerance do not need to eliminate all dairy foods from their diet. Many diary foods do not contain large amounts of lactose e.g. cheese contains virtually no lactose and yoghurt is generally well digested due to the natural bacterial culture it contains. In addition, the majority of people with lactose intolerance can consume up to two cups of milk a day without symptoms, if they consume it with food at different meal times. The amount of lactose that can be tolerated will vary from person to person. Speak to a dietitian about ways to help you include your three serves of calcium each day. Calcium supplements may be necessary if the intake of calcium from food sources is not adequate. Speak to your doctor or dietitian about whether you need to supplement your calcium intake.

How does Exercise Help?

Weight bearing exercise helps stimulate the bone cells to build bone. It also increases muscle strength and improves coordination, which help to prevent falls. A good form of weight bearing exercise is walking. Before you commence any exercise program, talk to your doctor.

Are there Gluten Free Medications to treat Osteoporosis?

There are several gluten free medications available that are suitable for people with coeliac disease. Speak to your doctor about the best treatment option for you.

How do these Medications work?

Some medications prevent further bone loss by decreasing bone resorption, while others actually increase bone strength by increasing bone formation. Both of these help reduce the risk of fracturing a bone.

What should I do if I have Osteoporosis?

Remaining active is very beneficial if you have osteoporosis. However, it is also important to avoid any activity thatmay cause you to fracture a bone, such as heavy lifting. Obtaining medical advice is important regardless of age. Treatment may be recommended that will help to substantially reduce the risk of fracturing a bone. It is never too late to treat osteoporosis.