Osteoporosis International

, Volume 19, Issue 12, pp 1705–1716 | Cite as

Bone in celiac disease

  • M.-L. BianchiEmail author
  • M. T. Bardella



Chronic inflammation and malabsorption in celiac disease (CD) can cause bone metabolism alterations and bone mineral loss in children and adults. Bone status before and after gluten-free diet, epidemiology of fractures, and possible treatment options for CD-related osteoporosis are presented. Controversial aspects of this complication of CD are discussed.

The relationship between bone derangements and celiac disease (CD) was recognized almost 50 years ago, but many questions are still open. We are now aware that osteoporosis is a relatively frequent atypical presentation of CD, especially in adults, and that undiagnosed CD can be the cause of osteoporosis and related fractures. Chronic inflammatory intestinal diseases, including CD, can affect bone and mineral metabolism because of alterations in both systemic and local regulatory factors. The pathogenetic processes are still controversial, but two main mechanisms seem to be involved: intestinal malabsorption and the presence of chronic inflammation. This review analyzes the published data on bone involvement in children, adolescents, and adults either before or after a gluten-free diet. Special attention is paid to the epidemiology of fractures in celiac patients, considering that fractures are a major complication of osteoporosis and an important problem in the management of a chronic disease like CD. The usefulness of screening osteoporotic patients systematically for CD is still an open question, but some rules can be given. Finally, the current treatment options for children and adults are discussed. Recommendations for future clinical research are proposed.


Bone density Celiac disease Cytokines Gluten Hyperparathyroidism Osteoporosis 


Conflicts of interest



  1. 1.
    Dube C, Rostom A, Sy R et al (2005) The prevalence of celiac diseases in average-risk and at-risk Western European populations: A systematic review. Gastroenterology 128:S57–S67PubMedCrossRefGoogle Scholar
  2. 2.
    Holtmeier W, Caspary WF (2006) Celiac disease: review. Orph J Rare Dis 1:3 (DOI  10.1186/1750-1172-1-3)
  3. 3.
    Rampertab SD, Pooran N, Brar P et al (2006) Trends in the presentation of celiac disease. Am J Med 19:9–14Google Scholar
  4. 4.
    Esteve M, Rosinach M, Fernández-Bañares F et al (2006) Spectrum of gluten-sensitive enteropathy in first-degree relatives of patients with celiac disease: clinical relevance of lymphocytic enteritis. Gut 55:1739–1745PubMedCrossRefGoogle Scholar
  5. 5.
    Shaoul R, Lerner A (2007) Associated autoantibodies in celiac disease. Autoimmun Reviews 6:559–565CrossRefGoogle Scholar
  6. 6.
    Trier JS (1998) Diagnosis of celiac sprue. Gastroenterology 115:211–216PubMedCrossRefGoogle Scholar
  7. 7.
    Dieterich W, Laag B, Schopper H (1998) Autoantibodies to tissue transglutaminase as predictors of celiac disease. Gastroenterology 115:1317–1321PubMedCrossRefGoogle Scholar
  8. 8.
    Bardella MT, Trovato C, Cesana BM et al (2001) Serological markers for celiac disease: is it time to change? Dig Liver Dis 33:426–431PubMedCrossRefGoogle Scholar
  9. 9.
    Marsh MN (1992) Gluten, major histocompatibility complex, and the small intestine. A molecular and immunologic approach to the spectrum of gluten sensitivity (celiac sprue). Gastroenterology 102:330–354PubMedGoogle Scholar
  10. 10.
    Green P, Jabri B (2003) Coeliac disease. Lancet 362:383–391PubMedCrossRefGoogle Scholar
  11. 11.
    Alaedini A, Green PHR (2005) Narrative review: Celiac disease: Understanding a complex autoimmune disorder. Ann Int Med 142:289–298PubMedGoogle Scholar
  12. 12.
    Green PHR, Cellier C (2007) Celiac disease. N Engl J Med 357:1731–1743PubMedCrossRefGoogle Scholar
  13. 13.
    Salvensen HA, Böe J (1953) Osteomalacia in sprue. Acta Med Scand 466:290–299Google Scholar
  14. 14.
    Melvin KEW, Hepner GW, Bordier P et al (1970) Calcium metabolism and bone pathology in adult coeliac disease. Q J Med 39:83–113PubMedGoogle Scholar
  15. 15.
    Caraceni MP, Molteni N, Bardella MT et al (1988) Bone and mineral metabolism in adult celiac disease. Am J Gastroenterol 83:274–277PubMedGoogle Scholar
  16. 16.
    Meyer D, Stavropolous S, Diamond B et al (2001) Osteoporosis in a North American adult population with celiac disease. Am J Gastroenterol 96:112–119PubMedGoogle Scholar
  17. 17.
    Ng DPK, Stone M, Hosking DJ, Long RG (1992) Calcium malabsorption in celiac sprue in not the result of vitamin D deficiency. Gastroenterology 102:A229Google Scholar
  18. 18.
    Corazza GR, Di Sario A, Cecchetti L et al (1995) Bone mass and metabolism in patients with celiac disease. Gastroenterology 109:122–128PubMedCrossRefGoogle Scholar
  19. 19.
    Selby PL, Davies M, Adams JE, Mawer EB (1999) Bone loss in celiac disease is related to secondary hyperparathyroidism. J Bone Miner Res 14:652–657PubMedCrossRefGoogle Scholar
  20. 20.
    Lemieux B, Bolvin M, Brossard JH et al (2001) Normal parathyroid function with decreased bone mineral density in treated celiac disease. Can J Gastroenterol 15:302–307PubMedGoogle Scholar
  21. 21.
    Clements MR, Davies M, Hayes ME et al (1992) The role of 1,25-dihydroxyvitamin D in the mechanism of acquired vitamin D deficiency. Clin Endocrinol (Oxf) 37:17–27CrossRefGoogle Scholar
  22. 22.
    Colston KW, Mackay AG, Finlayson C et al (1994) Localisation of vitamin D receptor in normal human duodenum and in patients with coeliac disease. Gut 35:1219–1225PubMedCrossRefGoogle Scholar
  23. 23.
    Staun M, Jarnum S (1998) Measurement of the 10,000-molecular weight calcium-binding protein in small-intestinal biopsy specimens from patients with malabsorption syndromes. Scand J Gastroenterol 23:827–832CrossRefGoogle Scholar
  24. 24.
    Vogelsang H, Suk EK, Janlsiw M et al (2000) Calcaneal ultrasound attenuation and vitamin-D-receptor genotypes in celiac disease. Scand J Gastroenterol 35:172–176PubMedCrossRefGoogle Scholar
  25. 25.
    Valdimarsson T, Arnqvist HJ, Toss G et al (1999) Low circulating insulin-like growth factor I in coeliac disease and its relation to bone mineral density. Scand J Gastroenterol 34:904–908PubMedCrossRefGoogle Scholar
  26. 26.
    Jameson S (2000) Coeliac disease, insulin-like growth factor, bone mineral density and zinc. Scand J Gastroenterol 35:894–896PubMedCrossRefGoogle Scholar
  27. 27.
    Jansson UHG, Kristiansson B, Magnusson P et al (2001) The decrease of IGF-I, IGF-binding protein-3 and bone alkaline phosphatase isoforms during gluten challenge correlates with small intestinal inflammation in children with coeliac disease. Eur J Endocrinol 144:417–423PubMedCrossRefGoogle Scholar
  28. 28.
    Bardella MT, Bianchi ML, Teti A (2005) Chronic inflammatory intestinal diseases and bone loss. Gut 54:1508PubMedGoogle Scholar
  29. 29.
    Moreno ML, Crusius JBA, Cherñavsky A et al (2005) The IL-1 gene family and bone involvement in celiac disease. Immunogen 57:618–620CrossRefGoogle Scholar
  30. 30.
    Taranta A, Fortunati D, Longo M et al (2004) Imbalance of osteoclastogenesis-regulating factors in patients with celiac disease. J Bone Miner Res 19:1112–1121PubMedCrossRefGoogle Scholar
  31. 31.
    Di Stefano M, Veneto G, Corrao G, Corazza GR (2000) Role of lifestyle factors in the pathogenesis of osteopenia in adult coeliac disease: a multivariate analysis. Eur J Gastroenterol Hepatol 12:1195–1199PubMedCrossRefGoogle Scholar
  32. 32.
    McFarlane XA, Bhalla AK, Reeves DE et al (1996) Osteoporosis in treated adult coeliac disease. Gut 36:710–714CrossRefGoogle Scholar
  33. 33.
    Kaukinen K, Peräaho M, Lindfors K et al (2007) Persistent small bowel mucosal villous atrophy without symptoms in coeliac disease. Aliment Pharmacol Ther 25:1237–1245PubMedGoogle Scholar
  34. 34.
    Fasano A, Catassi C (2005) Coeliac disease in children. Best Pract Res Clin Gastrenterol 19:467–478CrossRefGoogle Scholar
  35. 35.
    Mora S, Weber G, Barera G et al (1993) Effect of gluten-free diet on bone mineral content in growing patients with celiac disease. Am J Clin Nutr 57:224–228PubMedGoogle Scholar
  36. 36.
    Scotta MS, Salvatore S, Salvatoni A et al (1997) Bone mineralization and body composition in young patients with celiac disease. Am J Gastroenterol 92:1331–1334PubMedGoogle Scholar
  37. 37.
    Barera G, Mora S, Brambilla P et al (2000) Body composition in children with celiac disease and the effects of a gluten-free diet: a prospective case-control study. Am J Clin Nutr 72:71–75PubMedGoogle Scholar
  38. 38.
    Sdepanian VJ, De Miranda Carvalho CN, De Morais B et al (2003) Bone mineral density of the lumbar spine in children and adolescents with celiac disease on a gluten-free diet in Sao Paulo, Brazil. J Ped Gastroenterol Nutr 37:571–576CrossRefGoogle Scholar
  39. 39.
    Exner GU, Sacher M, Shmerling DH et al (1978) Growth retardation and bone mineral status in children with coeliac disease recognized after the age of 3 years. Helv Paediatr Acta 33:497–507PubMedGoogle Scholar
  40. 40.
    Hansen D, Bennedback FN, Hansen LK et al (2001) High prevalence of celiac disease in Danish children with type I diabetes mellitus. Acta Paediatr 90:1238–1243PubMedCrossRefGoogle Scholar
  41. 41.
    Diniz-Santos DR, Brandão F, Adan L et al (2007) Bone mineralization in young patients with type I diabetes mellitus and screening-identified evidence of celiac disease. Dig Dis Sci DOI  10.1007/s10620-007-9988-9
  42. 42.
    Bozzola M, Giovenale D, Bozzola E et al (2005) Growth hormone deficiency and coeliac disease: an unusual association? Clin Endocrinol 62:372–375CrossRefGoogle Scholar
  43. 43.
    Hamrick MW, Ferrari SL. Leptin and the sympathetic connection of fat to bone. Osteoporos Int. 2007 Oct 9; [Epub ahead of print]Google Scholar
  44. 44.
    Patel MS, Elefteriou F (2007) The new field of neuroskeletal biology. Calcif Tissue Int 80:337–347PubMedCrossRefGoogle Scholar
  45. 45.
    Ertekin V, Orbak Z, Selimoglu MA, Yildiz L (2006) Serum leptin levels in childhood celiac disease. J Clin Gastroenterol 40:906–909PubMedCrossRefGoogle Scholar
  46. 46.
    Mora S, Barera G, Ricotti A et al (1998) Reversal of low bone density with a gluten-free diet in children and adolescents with celiac disease. Am J Clin Nutr 67:477–481PubMedGoogle Scholar
  47. 47.
    Mora S, Barera G, Beccio S et al (1999) Bone density and bone metabolism are normal after long-term gluten-free diet in young celiac patients. Am J Gastroenterol 94:398–403PubMedCrossRefGoogle Scholar
  48. 48.
    Molteni N, Caraceni MP, Bardella MT et al (1990) Bone mineral density in adult celiac patients and the effect of gluten-free diet from childhood. Am J Gastroenterol 85:51–53PubMedGoogle Scholar
  49. 49.
    Challa A, Moulas A, Cholevas V et al (1998) Vitamin D metabolites in patients with coeliac disease. Eur J Pediatr 157:262–263PubMedGoogle Scholar
  50. 50.
    Tau C, Mautalen C, De Rosa S et al (2006) Bone mineral density in children with celiac disease. Effect of a gluten-free diet. Eur J Clin Nutr 60:358–363PubMedCrossRefGoogle Scholar
  51. 51.
    Cellier C, Flobert C, Cormier C et al (2000) Severe osteopenia in symptom-free adults with a childhood diagnosis of coeliac disease. Lancet 355:806PubMedCrossRefGoogle Scholar
  52. 52.
    Butcher GP, Banks LM, Walters JFR (1992) Reduced bone mineral density in coeliac disease - the need for bone densitometry estimations. Gut 33:S54Google Scholar
  53. 53.
    McFarlane XA, Bhalla A, Morgan L et al (1992) Osteoporosis: a frequent finding in treated adult coeliac disease. Gut 33(Suppl 2):S48Google Scholar
  54. 54.
    Valdimarsson T, Löfman O, Toss G, Ström M (1996) Reversal of osteopenia with diet in adult coeliac disease. Gut 38:322–327PubMedCrossRefGoogle Scholar
  55. 55.
    Bardella MT, Fredella C, Prampolini L et al (2000) Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten-free diet. Am J Clin Nutr 72:937–939PubMedGoogle Scholar
  56. 56.
    Pistorius LR, Sweidan WH, Purdie DW et al (1995) Coeliac disease and bone mineral density in adult female patients. Gut 37:639–642PubMedCrossRefGoogle Scholar
  57. 57.
    Corazza GR, Di Stefano M, Mauriño E, Bai JC (2005) Bones in coeliac disease: diagnosis and treatment. Best Pract Res Clin Gastrenterol 19:453–465CrossRefGoogle Scholar
  58. 58.
    WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis (WHO Technical Report Series no. 843). Geneva: World Health Organization 1994Google Scholar
  59. 59.
    Walters JRF, Banks LM, Butcher GP, Fowler CR (1995) Detection of low bone mineral density by dual energy x ray absorptiometry in unsuspected suboptimally treated coeliac disease. Gut 37:220–224PubMedCrossRefGoogle Scholar
  60. 60.
    Corazza GR, Di Sario A, Cecchetti L et al (1996) Influence of pattern of clinical presentation and of gluten-free diet on bone mass and metabolism in adult coeliac disease. Bone 18:525–530PubMedCrossRefGoogle Scholar
  61. 61.
    Mazure R, Vazquez H, Gonzalez D et al (1994) Bone mineral affection in asymptomatic adult patients with celiac disease. Am J Gastroenterol 89:2130–2134PubMedGoogle Scholar
  62. 62.
    Mustalahti K, Collin P, Sievãnen H et al (1999) Osteopenia in patients with clinically silent coeliac disease warrants screening. Lancet 354:744–745PubMedCrossRefGoogle Scholar
  63. 63.
    Bai D, Brar P, Holleran S et al (2005) Effect of gender on the manifestation of celiac disease: evidence for greater malabsorption in men. Scand J Gastroenterol 40:183–187PubMedCrossRefGoogle Scholar
  64. 64.
    Bai JC, Gonzalez D, Mautalen C et al (1997) Long-term effect of gluten restriction on bone mineral density in coeliac disease. Aliment Pharmacol Ther 11:157–164PubMedCrossRefGoogle Scholar
  65. 65.
    Sategna-Guidetti C, Grosso SB, Grosso S et al (2000) The effects of 1-year gluten withdrawal on bone mass, bone metabolism and nutritional status in newly-diagnosed adult coeliac disease patients. Aliment Pharmacol Ther 14:35–43PubMedCrossRefGoogle Scholar
  66. 66.
    Valdimarsson T, Toss G, Löfman O, Strõm M (2000) Three years’ follow-up of bone density in adult coeliac disease: significance of secondary hyperparathyroidism. Scand J Gastroenterol 35:274–280PubMedCrossRefGoogle Scholar
  67. 67.
    Kemppainen T, Kroger H, Janatuinen E et al (1999) Bone recovery after a gluten-free diet: a 5-year follow-up study. Bone 25:355–360PubMedCrossRefGoogle Scholar
  68. 68.
    Ciacci C, Maurelli L, Klain M et al (1997) Effects of dietary treatment on bone mineral density in adults with celiac disease: factors predicting response. Am J Gastroenterol 92:992–996PubMedGoogle Scholar
  69. 69.
    Matysiak-Budnik T, Malamut G, Patey-Mariaud de Serre N et al (2007) Long-term follow-up of 61 coeliac patient diagnosed in childhood: evolution toward latency is possible on a normal diet. Gut 56:1376–1386CrossRefGoogle Scholar
  70. 70.
    Ciacci C, Cirillo M, Mellone M et al (1995) Hypocalciuria in overt and subclinical celiac disease. Am J Gastroenterol 90:1480–1484PubMedGoogle Scholar
  71. 71.
    Molteni N, Bardella MT, Vezzoli G et al (1995) Intestinal calcium absorption as shown by stable strontium test in celiac disease before and after gluten-free diet. Am J Gastroenterol 90:2025–2208PubMedGoogle Scholar
  72. 72.
    Corazza GR, Di Sario A, Sacco G et al (1994) Subclinical coeliac disease: an anthropometric assessment. J Int Med 236:183–187Google Scholar
  73. 73.
    Kozanoglu E, Basaran S, Goncu MK (2005) Proximal myopathy as an unusual presenting feature of celiac disease. Clin Rheumatol 24:76–78PubMedCrossRefGoogle Scholar
  74. 74.
    Salvesen HA, Boe J (1953) Osteomalacia in sprue. Acta Med Scand 1466:290–299Google Scholar
  75. 75.
    Landolsi H, Bouajina E, Mankaï A et al (2006) Severe osteomalacia due to undiagnosed coeliac disease: three case reports of Tunisian women. Rheumatol Int 26:261–263PubMedCrossRefGoogle Scholar
  76. 76.
    Harzy T, Benbouazza K, Amine B et al (2005) An unusual case of osteomalacia as the presenting feature of coeliac disease. Rheumatol Int 26:90–91PubMedCrossRefGoogle Scholar
  77. 77.
    Byrne MF, Razak AR, Leader MB et al (2002) Disabling osteomalacic myopathy as the only presenting feature of coeliac disease. Eur J Gastroenterol Hepatol 14:1271–1274PubMedCrossRefGoogle Scholar
  78. 78.
    Basu RA, Elmer K, Babu A, Kelly CA (2000) Coeliac disease can still present with osteomalacia!. Rheumatology (Oxford) 39:335–336CrossRefGoogle Scholar
  79. 79.
    Viljamaa M, Collin P, Huhtala H et al (2005) Is coeliac diseases screening risk groups justified? A fourteen-year follow-up with special focus on compliance and quality of life. Aliment Pharmacol Ther 22:317–324PubMedCrossRefGoogle Scholar
  80. 80.
    Fritzsch J, Hennicke G, Tannapfel A (2005) 10 frakturen in 21 jahren. Unfallchirurg 108:994–997PubMedCrossRefGoogle Scholar
  81. 81.
    Vazquez H, Mazure R, Gonzalez D et al (2000) Risk of fractures in celiac disease patients: a cross-sectional, case-control study. Am J Gastroenterol 95:183–189CrossRefGoogle Scholar
  82. 82.
    Fickiling WE, McFarlane XA, Bhalla AK, Robertson DA (2001) The clinical impact of metabolic bone disease in coeliac disease. Postgrad Med J 77:33–36CrossRefGoogle Scholar
  83. 83.
    Moreno ML, Vazquez H, Mazure R et al (2004) Stratification of bone fracture risk in patients with celiac disease. Clin Gastroenterol Hepatol 2:127–134PubMedCrossRefGoogle Scholar
  84. 84.
    Thomason K, West J, Logan RF et al (2003) Fracture experience of patients with celiac disease: a population-based study. Gut 52:518–522PubMedCrossRefGoogle Scholar
  85. 85.
    Vestergaard P, Mosekilde L (2002) Fracture risk in patients with celiac Disease, Crohn’s disease, and ulcerative colitis: a nationwide follow-up study of 16,416 patients in Denmark. Am J Epidemiol 156:1–10PubMedCrossRefGoogle Scholar
  86. 86.
    West J, Logan RFA, Card TR et al (2003) Fracture risk in people with celiac disease: a population-based cohort study. Gastroenterology 125:429–436PubMedCrossRefGoogle Scholar
  87. 87.
    Davie MW, Gaywood I, George EJ et al (2005) Excess non-spine fractures in women over 50 years with celiac disease: a cross-sectional, questionnaire-based study. Osteoporos Int 16:1150–1155PubMedCrossRefGoogle Scholar
  88. 88.
    Jafri MR, Nordstrom CW, Murray JA et al (2007) Long-term fracture risk in patients with celiac disease: a population-based study in Olmted County, Minnesota. DOI  10.1007/s10620-007-9976-0
  89. 89.
    Ludvigsson JF, Michaelsson K, Ekbom A, Montgomery SM (2007) Coeliac disease and the risk of fractures - a general population-based cohort study. Aliment Pharmacol Ther 25:273–285PubMedGoogle Scholar
  90. 90.
    Olmos M, Antelo M, Vazquez H et al (2008) Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease. Dig Liver Dis 40:46–53PubMedCrossRefGoogle Scholar
  91. 91.
    National Institute of Health (2005) Consensus Development Conference Statement on Celiac Disease; June 28–30, 2004. Gastroenterology 128(4 Supp 1):S1-S9Google Scholar
  92. 92.
    Lindh E, Ljunghall S, Larsson K, Lavö B (1992) Screening for antibodies against gliadin in patients with osteoporosis. J Int Med 231:403–406Google Scholar
  93. 93.
    Eastell R (1998) Practical management of the patient with osteoporotic fracture. In: Meunier PJ (ed) Osteoporosis: diagnosis and management. Martin Dunitz, London, pp 175–190Google Scholar
  94. 94.
    Mather KJ, Meddings JB, Beck PL et al (2001) Prevalence of IgA-antiendomysial antibody in asymptomatic low bone mineral density. Am J Gastroenterol 96:120–125PubMedCrossRefGoogle Scholar
  95. 95.
    Armagan O, Uz T, Tascioglu F et al (2005) Serological screening for celiac disease in premenopausal women with idiopathic osteoporosis. Clin Rheumatol 24:239–243PubMedCrossRefGoogle Scholar
  96. 96.
    Drummond FJ, Annis P, O’Sullivan K et al (2003) Screening for asymptomatic celiac disease among patients referred for bone densitometry measurement. Bone 33:970–974PubMedCrossRefGoogle Scholar
  97. 97.
    O’Leary C, Feighery C, Feighery A et al (2002) The prevalence of coeliac disease among female subjects having bone densitometry. Ir J Med Sci 171:145–147PubMedCrossRefGoogle Scholar
  98. 98.
    Sanders DS, Patel D, Khan FB et al (2005) Case-finding for adult celiac disease in patients with reduced bone mineral density. Dig Dis Sci 50:587–592PubMedCrossRefGoogle Scholar
  99. 99.
    Stenson WF, Newberry R, Lorenz R et al (2005) Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis. Arch Intern Med 165:393–399PubMedCrossRefGoogle Scholar
  100. 100.
    Lupatelli G, Fuscaldo G, Castellucci G et al (1994) Severe osteomalacia due to gluten-sensitive enteropathy. Ann Ital Med Int 9:40–43Google Scholar
  101. 101.
    Gannage MH, Abikaram G, Nasr F, Awada H (1998) Osteomalacia secondary to celiac disease, primary hyperparathyroidism, and Graves’ disease. Am J Med Sci 315:136–139PubMedCrossRefGoogle Scholar
  102. 102.
    Bianchi ML, Bardella MT (2002) Bone and celiac disease. Calcif Tissue Int 71:465–471PubMedCrossRefGoogle Scholar
  103. 103.
    Scott EM, Gaywood I, Scott BB, for the British Society of Gastroenterology (2000) Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease. Gut 46(Suppl I)i1-i8Google Scholar
  104. 104.
    Hepner GW, Jowsey J, Arnaud C et al (1978) Osteomalacia and celiac disease: response to 25-hydroxyvitamin D. Am J Med 65:1015–1020PubMedCrossRefGoogle Scholar
  105. 105.
    Mautalen C, Gonzalez D, Mazure R et al (1997) Effect of treatment on bone mass, mineral metabolism and body composition in untreated celiac disease patients. Am J Gastroenterol 92:313–318PubMedGoogle Scholar
  106. 106.
    Walters JRF (1994) Bone mineral density in coeliac disease. Gut 35:150–151PubMedCrossRefGoogle Scholar
  107. 107.
    Pazianas M, Butcher GP, Subhani JM et al (2005) Calcium absorption and bone mineral density in celiacs after long term treatment with gluten-free diet and adequate calcium intake. Osteoporos Int 16:56–63PubMedCrossRefGoogle Scholar
  108. 108.
    Kupper C (2005) Dietary guidelines and implementation for celiac disease. Gastroenterology 128:S121–S127PubMedCrossRefGoogle Scholar
  109. 109.
    Meek SE, Nix K (2007) Hypocalcemia after alendronate therapy in patients with celiac disease. Endoc Pract 13:403–407Google Scholar
  110. 110.
    Hill ID, Dirks MH, Liptak GS et al (2005) Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 40:1–19PubMedCrossRefGoogle Scholar
  111. 111.
    Lewis NR, Scott BB (2005) Should patients with coeliac disease have their bone mineral density measured? Eur J Gastroenterol Hepatol 17:1065–1070PubMedCrossRefGoogle Scholar
  112. 112.
    McGough N, Cummings JH (2005) Coeliac disease: a diverse clinical syndrome caused by intolerance of wheat, barley and rye. Proc Nutr Soc 64:434–450PubMedCrossRefGoogle Scholar
  113. 113.
    Murray JA (2006) Celiac disease in patients with an affected member, type 1 diabetes, iron-deficiency, or osteoporosis? Gastroenterology 128:S52–S56CrossRefGoogle Scholar
  114. 114.
    Bianchi ML, Bardella MT. Celiac disease: its effects on bone. (DOI  10.1138/20060212) IBMS BoneKEy - Osteovision 2006 3:30–38

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© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  1. 1.Bone Metabolism Unit, Istituto Auxologico Italiano IRCCSMilanItaly
  2. 2.Center for prevention and diagnosis of celiac disease, Fondazione IRCCS Ospedale Maggiore PoliclinicoMilanItaly

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