Osteomalacia is a well-recognized, although uncommon, complication of celiac disease, with bone pain and pseudofractures as features. It is associated with elevated alkaline phosphotase and often normal levels of calcium and phosphate. It usually responds well to a gluten-free diet and calcium and vitamin D supplementation.
Osteoporosis, which is common in adults with celiac disease, affects both men and women, and the exact mechanisms are not clear. The prevalence of osteoporosis is even higher in refractory sprue compared to gluten-free-diet-responsive patients. Diagnosis depends on bone mineral density testing with a T-score less than 2.5 SD below mean peak value in young adults. The primary treatment for the osteoporosis in a celiac is the strict gluten-free diet with adequate calcium (1500mgday_1 and vitamin D). Other measures directed at preserving or building bone density may be necessary if the boss mineral loss has been substantial or does not recover with a gluten-free diet.
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