Management of osteoporosis

How to minimise the risk

Follow a gluten-free diet

Bone loss starts to exceed bone replacement after the age of 35. For people with coeliac diseaseA condition where a person is unable to eat gluten as it makes their body attack itself. the most important factor in reducing the risk of osteoporosisA condition where your bones lose bone mass and become brittle. is adhering to the glutenA protein that is found in the cereals wheat, barley and rye. -free diet. 

Avoid other risk factors    

Patients should be given general advice about exercise (particularly weight bearing), smoking, excess alcohol consumption, and adequate dietary calcium.

Meeting calcium requirements

It is recommended that adults with coeliac disease should have between 1000 milligrams (mg) and 1500mg of calcium each day.  This is based on the British Society of Gastroenterology (BSGBritish Society of Gastroenterology - an organisation focused on the promotion of gastroenterology within the United Kingdom, with a membership drawn from physicians, surgeons, pathologists, radiologists, scientists, nurses, dietitians, and others interested in the field. The BSG is a registered charity.), guidelines for osteoporosis in inflammatory bowel disease and coeliac disease (2007), and the recent review document from the BSG on the management of adults with coeliac disease (2010).

The use of supplements should be decided on an individual basis. 

Calcium requirement in children

There are no guidelines that recommend a higher requirement for calcium in children with coeliac disease. Following a calcium rich gluten-free diet is recommended by using Reference Nutrient Intake (RNI) values as a guide (see below) depending on the individual case.

1-3 years: 350 mg
4-6 years: 450 mg
7-10 years: 550 mg
11-18 years (female): 800 mg
11-18 years (male): 1000 mg

Calcium requirement in mothers

There are no specific recommendations for lactating mothers who have coeliac disease. An additional 550mg per day is recommended for all women while breastfeeding.

Calcium sources in the diet for those with lactose intolerance

Dairy products (milk, yoghurt, cheese) provide useful sources of dietary calcium.  Where milk allergy or lactose intolerance is present, patients may obtain calcium from non-dairy sources such as calcium-enriched soya milk, fish with edible bones, for example, salmon and sardines, tofu, baked beans and dried figs.   

The treatment of osteoporosis

The management of low bone mineral densityThe strength of your bones. The lower your bone mineral density, the greater your risk of breaking bones. Bone mineral density is measured by having a bone density scan known as a Dual Energy X-ray Absorptiometry (DEXA) scan. in those with coeliac disease should be advised on an individual basis. 

Recommendations are to:

• maintain adherence to the gluten-free diet

• take adequate dietary calcium, using supplements if necessary

• regular weight bearing exercise

• stop smoking and avoid excess alcohol.

Medications such as bisphosphonates and strontium ranelate may be used as appropriate.

In cases where the gluten-free diet does not improve bone health, additional secondary causes of osteoporosis should be ruled out.

These causes include: 

• corticosteroids 
• untreated hypogonadism
• thyroid dysfunction
• hyperprolactinemia
• medications (anticonvulsants).

You may wish to download our information leaflet on coeliac disease and osteoporosis for your patients. It provides information on the amount of calcium in different foods. You can also access information on the amount of calcium in vegetarian foods in the vegetarian section of our website.

References

1 Lewis NR, Scott BB for the British Society of Gastroenterology (2007)  Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease.  Accessed at http://www.bsg.org.uk/