Celiac Disease and Bone Loss: Why Early Screening Matters—Even for Young Adults

If you've recently been diagnosed with celiac disease, your doctor might recommend a bone density scan. You might wonder why—after all, bone problems sound like something that happens to older people, right? But a new study of over 600 patients suggests that bone loss is surprisingly common even in younger adults with celiac disease, and catching it early could prevent serious fractures down the road.

The Surprising Bone Loss Numbers

Researchers at the University of Bologna in Italy found that low bone mineral density (BMD)—essentially, bones that are less dense and stronger than they should be—showed up in more than 17% of their study participants overall. Even more striking: among young adults aged 25-34, the rate was 13.4%. While these numbers might not sound alarming compared to older populations, the real concern is what happens over time.

"People with celiac disease have around a 30% higher risk of any fracture compared with the general population," explained Dr. Francesco Tovoli, who led the research. Some studies even report higher risks for major osteoporotic fractures—the kind that can seriously impact quality of life.

Why Does Celiac Disease Affect Bones?

The connection between celiac disease and bone health comes down to absorption. When someone has celiac disease, their immune system reacts to gluten by damaging the small intestine, which makes it harder to absorb crucial nutrients—especially calcium and vitamin D. These two nutrients are essential for building and maintaining strong bones.

But it's not just about calcium and vitamin D. Researchers found that bone loss in celiac patients is multifactorial, meaning several things contribute at once: systemic inflammation, hormonal changes, and broader nutritional deficiencies all play a role. Interestingly, some patients experience bone loss even without obvious digestive symptoms.

Who's at Highest Risk?

The risk of bone loss isn't equal for everyone with celiac disease. Patients showing signs of malabsorption—like low body weight, weight loss, or iron-deficiency anemia—face the greatest risk. People diagnosed later in life and those who don't stick closely to a gluten-free diet also have higher fracture risks.

To Screen or Not to Screen: That's the Question

Here's where things get complicated. Different countries recommend different approaches. The American College of Gastroenterology suggests a DEXA scan (a painless bone density test) at the time of celiac diagnosis. Other countries prefer a more selective, risk-based approach—only screening patients who show specific warning signs.

The Italian study compared both strategies. Using a risk-based tool called the NOGG algorithm, researchers found that 67% of patients could have skipped the DEXA scan without missing important cases. However, this approach would have meant missing 15.7% of patients with low bone density for their age.

"One size doesn't fit all," Dr. Tovoli emphasized. The choice depends on your healthcare system's resources and priorities. In regions with abundant resources and high rates of bone loss, universal screening makes sense. In areas with limited resources, a targeted approach might be more practical.

The Good News: A Gluten-Free Diet Helps

Here's something encouraging: a well-balanced gluten-free diet actually helps restore bone density. When people stick to a gluten-free diet and absorb nutrients properly again, their bone health improves. The key is ensuring the diet includes adequate calories and proper nutrient composition—and that's where nutritional counseling comes in.

"Calcium intake may be suboptimal if the diet is overly restrictive or lacks proper counseling," Dr. Tovoli noted, which is why working with a dietitian familiar with celiac disease can make a real difference.

What This Means for You

If you've been recently diagnosed with celiac disease, talk to your doctor about bone health screening. Even if you're young and feel fine, early detection of bone loss can help prevent fractures later in life. And remember: following a gluten-free diet isn't just about managing your digestive symptoms—it's also about giving your bones the chance to rebuild and strengthen.