Celiac disease is a serious autoimmune condition that affects more than just the digestive system – it can also have a major impact on bone health. When someone with celiac disease eats gluten, it triggers inflammation that damages the small intestine and makes it harder to absorb key nutrients. Over time, this can lead to problems like anemia, nerve issues, stunted growth, and weakened bones. Nutrients that are especially important for people with celiac disease include calcium, vitamin D, iron, vitamin B12, folic acid, and zinc.
Osteoporosis is a condition that causes bones to become weak and more likely to break. It is present in up to 26-72% of people at the time of celiac disease diagnosis, even in those without digestive symptoms. Because of this, bone density scans (DEXA scans) are frequently recommended when celiac disease is diagnosed or after one year on a gluten-free diet. While intestinal healing and nutrient absorption usually improve once someone begins a strict gluten-free diet, addressing bone health remains an essential part of long-term celiac disease management.
Nutrition and Strong Bones
The good news: once celiac disease is diagnosed and treated with a strict gluten-free diet, your body can start healing and absorbing nutrients again. Still, some people need extra support to get enough calcium, vitamin D, vitamin K, and magnesium.
Try including:
- Calcium: salmon (with bones), tofu, leafy greens, almonds, chia seeds
- Vitamin D: salmon, eggs, mushrooms, or safe sunlight exposure
- Vitamin K: spinach, kale, collards, and broccoli
- Magnesium: pumpkin seeds, quinoa, and potatoes
A registered dietitian can help you identify gaps in your diet, recommend supplements if needed, and create a plan that supports both your bones and your gluten-free lifestyle.
For more practical tips, recipes, and expert insights, watch our Culinary Medicine Webinar on Bone Health.
Raising Awareness
Celiac disease is often a silent, but significant contributor to bone loss across the lifespan. Missed or delayed diagnosis, particularly in children, can have lasting consequences for skeletal development and peak bone mass. Optimal bone health requires a coordinated approach to care that includes gastroenterologists, endocrinologists, and dietitians to address nutrient deficiencies, monitor bone density, and implement individualized nutrition interventions. World Osteoporosis Day is an opportunity to advocate for earlier recognition of celiac disease, as well as Medical Nutrition Therapy legislation and interventions that will assist with dietary management of disease, stronger collaboration across specialties, and policies that support comprehensive bone health care for this population.
References:
Therrien A, Kelly CP, Silvester JA. Celiac Disease: Extraintestinal Manifestations and Associated Conditions. J Clin Gastroenterol. 2020 Jan;54(1):8-21.
Lebovits J, Lee AR. Micronutrient Considerations for Celiac Disease. Practical Gastroenterology. 2023;47(10):26-42.
Lebwohl B, Rubio-Tapia A. Epidemiology, Presentation, and Diagnosis of Celiac Disease. Gastroenterology. 2021 Jan;160(1):63-75.
Zylberberg HM, Miller EBP, Reidy D, Avery K, Newberry C, Ratner A, Silberg DG. Delay in Celiac Disease Diagnosis Among Patients with High-Risk Screening Conditions: Results from a United States Claims Database. J Clin Med. 2025 Sep 14;14(18):6471.