Wednesday, April 30, 2008


People who have lived with untreated celiac disease are at an above-average risk for osteoporosis. So it is a good idea to have one's bone density tested subsequent to a positive diagnosis for celiac disease.

If the patient turns out to have osteoporosis, it is likely that therapies will be considered. The very good news is that patients seem to have a very good track record rebuilding at least some bone density through a well-rounded gluten-free diet, supplementation, and exercise. However, physicians may also suggest medicinal therapy involving bisphosphonates such as Fosamax and Reclast.

Before beginning a regimen of such drugs, it is a good idea to thoroughly discuss the risks and benefits with an informed specialist. With Fosamax, there has been some concern over stress fractures and slow healing after continuing use of the drug for more than five years; with a drug such as Reclast, it seems that patients should be vetted for possible osteonecrosis of the jaw. And just this January, the FDA issued a warning about severe bone, joint, and/or muscle pain due to such bisphosphonates.

Furthermore, recent studies now suggest that women on Fosamax and Reclast may also risk atrial fibrillation.

There still may be good rationales for treating osteoporosis with these medications; it just seems to be a good idea to weigh the pluses and minuses while keeping in mind that, for people newly diagnosed with celiac disease as well as osteoporosis, simply adopting a gluten-free diet and getting appropriate nutrition can yield very good results.

As a layperson, I also find that general screening for osteoporosis looks better and better to me. In many cases, the condition seems to be more improvable the sooner it is detected, so I don't see the harm in getting baseline diagnoses early (even in one's twenties) and perhaps every ten years after that to heighten the chance of nipping the condition in the bud and perhaps reversing it before it becomes more serious. The same goes for celiac disease, especially among people who display risk factors such as chronic fatigue, gastrointestinal problems, and/or having a first or second degree relative who has been conventionally diagnosed. In both cases, early detection can lead to early, relatively simple treatment that leads to greater success with fewer medications.

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