Health complications

Undiagnosed and untreated coeliac disease may contribute to developing health complications such as osteoporosis and certain kinds of cancer. 

On this page we discuss what osteoporosis is, why having coeliac disease is a risk factor for developing osteoporosis, how to get tested, and what you can do to help minimise the risk.  

What is osteoporosis?

Osteoporosis is a condition where the body's bones become brittle and more likely to break.  It's diagnosed by measuring Bone Mineral Density (BMD) which assesses the strength of bones.  People with osteoporosis have a low BMD.  Osteopenia describes a BMD which is lower than normal, but not as severe as in osteoporosis.

As well as coeliac disease, there are other factors which contribute to an increased risk of osteoporosis including excessive alcohol consumption, smoking and being underweight. The risk is also increased in post menopausal women. 

How does coeliac disease contribute to the risk of osteoporosis?

Coeliac disease is most often diagnosed in adults between the ages of 40-60 years. Research shows that the average time it takes for someone to get diagnosed with coeliac disease is 13 years - so diagnosis is often significantly delayed. It's the long term reduced absorption of bone forming nutrients such as calcium, caused by the gut damage from eating gluten, that puts adults with coeliac disease at risk of osteoporosis.

The maximum bone density that a person can reach in their lifetime is called the 'peak bone mass'. It's accepted that most people reach their peak bone mass in their late 20's to early 30's. 

As part of the natural aging process, after peak bone mass is reached, bone mass starts to fall. 

An additional consideration for women is that bone mineral loss increases after going through the menopause due to the lack of hormone (oestrogen) production.

People who've been diagnosed with coeliac disease in later life, who may have had the condition undiagnosed for many years, might not have reached their peak bone mass, therefore making it more likely that their bone mineral density will be lower than expected.

Getting tested for osteoporosis

If you feel you may be at risk from osteoporosis, it's advisable to speak to your GP. Osteoporosis is diagnosed by a bone scan, known as a Dual Energy X-ray Absorptiometry (DEXA) scan, which measures your BMD. Depending on your age at diagnosis of coeliac disease, your doctor may recommend you have a DEXA scan.

What's the treatment for osteoporosis and how do I minimise the risk?

Treatment will depend on your individual circumstances and results of your DEXA scan.

Optimising your bone health is important.

You can do this by:

• following a strict gluten-free diet to ensure you absorb all the nutrients from the food you eat
• eating a nutritionally balanced gluten-free diet, rich in calcium. 
  
  Calcium requirements are higher for adults with coeliac disease compared to people without the condition, so it's important to eat enough!
  
  The daily recommendation for calcium for adults (over 18 years of age) with coeliac disease is 1000mg per day; for postmenpausal women and men over 55 years, the daily recommended amount is 1200mg.  
  
  Click here to download a basic leaflet about eating enough calcium.
  
  For specific guidance on using calcium supplements, refer to your healthcare team.
• taking regular weight-bearing exercise such as walking, jogging, gardening
• stopping smoking
• avoiding excessive alcohol intake

If you have osteoporosis, in addition to the pointers above, there are drug treatments that can be used to lower the risk of bones breaking - your doctor will be able to advise and monitor you. 

What about childrens' bone health?

So long as a child with coeliac disease follows a well balanced gluten-free diet, the outlook for their bone health is very good. This is because absorption of calcium and other bone forming nutrients will improve as their gut heals, allowing them to develop normally. Children and young adults who follow their gluten-free diet should be able to reach their optimum level of bone mass, so minimising the risk of developing osteoporosis in the future.

As with adults with coeliac disease, it's also important that children eat a healthy balanced diet. There are no increased calcium requirements for children with coeliac disease compared to other children.

Coeliac UK's booklet 'Gluten-free living for children: Out and About', which is downloadable in the Members area of our website, gives basic information about eating a balanced gluten-free diet. To sign up as a Member click here. 

Children's nutritional requirements vary according to their age, so for specific guidance about your child, it's best to talk to their dietitian.

Further information

For further details, see our information leaflet on osteoporosis, which is available to download in the Members area of our website or by calling our Helpline on 0870 444 8804.

You may also want to contact the National Osteoporosis Society or call their helpline 0845 450 0230.