FOCUS ON MALE OSTEOPOROSIS

Addendum: A related article appeared on Science Daily (July 25, 2008) soon after most of the following was originally posted. Note, however, that the claim that "It is widely known that among adults [with celiac disease] gluten-free diet alone is not sufficient make the bone damage regress" is something of an overstatement, as a calcium rich gluten-free diet can result in at least some improvement.

Celiac disease is a risk factor for osteoporosis, including male osteoporosis, as noted in Dawn Klingensmith's Philadelphia Inquirer article "Tough Men, Brittle Bones" (July 28, 2008).

As described in Celiac Disease: A Hidden Epidemic, osteoporosis or some other form of bone disease is actually common among people with undiagnosed celiac disease, with the men tending to have the lower bone density.

Approximately 75 percent of newly diagnosed patients with celiac disease have some degree of bone loss. Recent studies show that up to 35 percent of adults who are newly diagnosed with celiac disease have established osteoporosis. While both osteoporosis and celiac disease are more common in women, low bone density is an equal-opportunity complication in the celiac community. And men with celiac disease tend to have more severe osteoporosis.

So doctors and patients should be alert to the possibility that men can have osteoporosis, and that celiac disease is a risk factor. A man (or woman) who tests positive for celiac disease should be considered as also being at risk for osteoporosis—even when a CBC doesn't send up any red flags, the celiac diagnosis is in itself a red flag. Likewise a patient who tests positive for osteoporosis or osteopenia should be considered as possibly having untreated celiac disease—especially if a cause of the condition seems hard to determine. [See related article.]

Many medical professionals may recommend testing for osteoporosis for patients at an advanced or after a fracture. However, in this layperson's opinion, an early baseline test is worth serious consideration.

As noted elsewhere in this blog, current drug therapies for osteoporosis seem to yield encouraging results, but there may be significant negative side effects from, say, taking oral bisphosphonates for more than five consecutive years, or from taking intravenous treatment if a patient is not properly vetted for dental and other issues.

If early testing (say, between 20 and 40) reveals a bone density problem, the condition may be largely or entirely treatable with diet and exercise, even if the patient has just started a gluten-free diet after being newly diagnosed with celiac disease. Celiac Disease: A Hidden Epidemic puts it this way: "The overwhelming evidence and statistics that connect celiac disease to osteopenia and osteoporosis make a compelling case for prevention as well as early screening for the conditions. Early diagnosis and therapy are critical to permit patients with celiac disease to achieve normal peak bone mass and then maintain it."