Celiac Disease and Bone Health

People with celiac disease are well aware of the effects their conditions have on their digestive system. What they often don’t know is how celiac disease also affects other body systems, including their bones. One of the biggest concerns for people with celiac disease is the strong connection between this condition and osteoporosis.

Those diagnosed with celiac disease also have a 3.5 percent chance of being diagnosed with osteoporosis. That’s in comparison to 0.5 percent in the general population. Not to mention, those with celiac disease also have double the risk of bone fractures.

What’s Celiac Disease?

Before we explore the connection between celiac disease and bone health, let’s understand what each of these conditions entails. Celiac disease is an inherited intestinal disorder in which the body cannot tolerate gluten. A protein found in wheat, rye, barley, and bulgur, gluten is present in many of the foods we eat every day.

However, when people with celiac disease consume foods with gluten, their immune system responds by attacking and damaging the lining of the small intestine. When the lining is damaged, so is its ability to absorb nutrients from food into the bloodstream properly.

What’s Osteoporosis?

Osteoporosis is a condition in which the bones become less dense, increasing their chance of fracture. In the United States, over 53 million people either have risk or are at high risk of developing osteoporosis due to low bone mass. There are many risk factors for osteoporosis, including:

  • Not enough calcium
  • Not enough vitamin D
  • A family history of osteoporosis
  • Smoking
  • Drinking too much alcohol
  • Lack of physical activity
  • Prolonged use of medications
  • Abnormal absence of menstrual periods
  • Being postmenopausal or having an early menopause

The Connection between Celiac Disease and Bone Health

Most people don’t realize, celiac disease is a risk factor for osteoporosis. The effects of celiac disease and the damage to the small intestine can cause malabsorption. The nutrients that are not absorbed by people with celiac disease include calcium and Vitamin D, both essential for bone health.

Therefore, it is common for children and adults with celiac disease to be at high risk of osteoporosis. Even people who follow a gluten-free diet and consume enough calcium can still be deficient.

The exact connection between celiac disease and bone health remains unknown, but there are several possible reasons for it, including:

  • Celiacs are prone to have vitamin D deficiency
  • Calcium malabsorption
  • Magnesium malabsorption
  • Chronic inflammation

These factors place the prevalence of osteoporosis in newly diagnosed celiac disease patients as high as 75 percent.

How to Know If You’re at Risk

If you’ve been diagnosed with celiac disease, you should aim to get a bone density test. A bone mineral density (BMD) test, essentially measures bone density in various sites of the body. This is a painless test used to detect osteoporosis before a fracture occurs. It also helps predict your chances of fracturing in the future. Talk to your doctor to see if you’re a qualified patient for a BMD test.

Caring for Bone Health with a Gluten-Free Diet

The best way to manage celiac disease is by following a gluten-free diet. Luckily, for most people with celiac disease following a gluten-free diet should be enough to resume normal absorption of nutrients within a few months. Those who have adopted a gluten-free diet and have finally reached average levels of nutrient absorption, should follow the same bone health strategies as those who don’t have celiac disease. These caring strategies include getting adequate calcium and vitamin D, following an exercise routine, avoid smoking and excessive alcohol use, and in some cases, consider osteoporosis treatment medication.

Looking at Nutrition

A well-balanced diet is key for healthy bones and nutrition, especially for people with celiac disease. It’s essential to make sure you’re incorporating calcium-rich foods into your healthy diet, as well as foods rich in calcium to help support your bone health. Some foods to include in your diet:

  • Low-fat dairy-free products
  • Dark green, leafy greens
  • Calcium-fortified foods and beverages
  • Sardines
  • Kidney beans
  • Almonds
  • Sesame seeds
  • Tofu
  • Chia seeds
  • Oranges
  • Edamame

You also want to incorporate vitamin D rich foods that support calcium absorption and bone health. Some foods include:

  • Fatty fish, like tuna and salmon
  • Fortified foods like orange juice and cereal
  • Beef liver
  • Cheese
  • Egg yolk


Much like your muscles, bones respond to exercise by becoming stronger. Resistance training and weight-bearing activities are the best options to support bone health. Think of exercises like walking, climbing stairs, and dancing if you prefer weight-bearing workouts. For those that prefer resistance training look for weight lifting, Crossfit, and Pilates to strengthen the bones.

Many types of exercise can strengthen the muscles that support your bones to improve balance and flexibility while preserving joint mobility. All of these things help reduce your likelihood of falling and suffering a bone fracture.


Last but not least, people with celiac disease must consider incorporating critical vitamins and minerals to support their health. People who eat a gluten-free diet tend to be deficient in many vitamins, as their daily intakes often don’t meet the recommendations. Nutrients you may need to supplement include:

  • Vitamin B6 and B12 – they help fight infections and fatigue
  • Folate – critical for helping the body make new cells
  • Vitamin D – essential to allow our bodies to absorb calcium
  • Calcium – the key to bone health

Keep in mind, focusing on vitamin-rich foods alone does not eliminate your need to take supplements. In most occasions, diet alone is not enough to meet the recommended daily intake of most of these vitamins and minerals. Take a look at the recommended amount for these vital supplements.


Children 1-3 years old: 700 milligrams (mg)

Children 4-8 years old: 1,000 milligrams (mg)

Children 9-18 years old: 1,300 milligrams (mg)

Adults 19-50 years old: 1,000 milligrams (mg)

Women 51 to 70 years old: 1,200 milligrams (mg)

Men 51 to 70 years old: 1,000 milligrams (mg)

Women and men 71 and older: 1,200 milligrams (mg)

Vitamin D

Age 1-70: 600 International Units (IU)

Age 71 and older: 800 International Units (IU)

If you’re not getting enough of these minerals and your doctor believes you’re at risk for osteoporosis, they may recommend higher levels of calcium, and vitamin D. As always, speak with your doctor if you’re unsure of the right amount you should take.

Keep in Mind

Your doctor might recommend osteoporosis medications as part of the treatment. These often include calcitonin, hormone therapy to help with estrogen levels, and bisphosphonates, to name a few. Talk with your doctor to make sure you’re taking the proper supplements to help with your condition. Always remember to include vitamin D and calcium supplements into your daily diet, and incorporate vitamin-rich foods into your diet, to make sure you are doing what’s best for your bone health.