Yes, celiac disease can cause osteoporosis, and it does so more often than most people realize. Between 18% and 35% of celiac patients have osteoporosis at diagnosis, and roughly 40% have osteopenia, the earlier stage of bone thinning. Even young adults in their twenties and thirties with celiac disease show reduced bone density compared to healthy peers.
How Celiac Disease Weakens Bones
Celiac disease damages the lining of the small intestine, flattening the tiny finger-like projections (villi) that absorb nutrients from food. This shrinks the intestine’s absorbing surface area and directly impairs the uptake of calcium, one of the primary building blocks of bone. Calcium metabolism is altered in virtually all untreated celiac patients, and roughly three-quarters of those with obvious malabsorption symptoms have significant bone mineral loss at the time of diagnosis. Even people with mild or “silent” celiac symptoms show similar degrees of bone thinning.
The damage goes beyond simple nutrient deficiency. Celiac disease triggers chronic inflammation that activates osteoclasts, the cells responsible for breaking down bone tissue. In celiac patients, the balance between bone-building and bone-breakdown signaling tips toward destruction. Studies measuring key bone-regulating proteins in the blood find that celiac patients have a ratio that favors resorption, and this imbalance correlates directly with lower bone density in the spine.
The Vitamin D and Calcium Problem
Vitamin D deficiency is extremely common in untreated celiac disease. The damaged intestinal lining absorbs less vitamin D from food, and many celiac patients also eat less and get less sun exposure. About 68% of untreated patients are deficient in the storage form of vitamin D at diagnosis.
When calcium absorption drops, the body compensates by ramping up parathyroid hormone (PTH) production, a condition called secondary hyperparathyroidism. PTH pulls calcium out of bones to maintain blood calcium levels, which keeps your heart and muscles working but slowly hollows out your skeleton. Research has found a direct negative relationship between PTH levels and bone density in celiac patients: the higher the PTH, the thinner the bones, particularly in the forearm.
Fracture Risk With Celiac Disease
A large UK study tracking thousands of celiac patients found that their overall fracture risk was about 30% higher than the general population. For hip fractures specifically, the risk nearly doubled, with a hazard ratio of 1.9. Forearm fractures were 77% more likely. These numbers translate to a meaningful real-world impact: an additional 10 to 16% of celiac patients can expect a hip fracture directly related to their disease over their lifetime. After age 75, the gap widens further.
Notably, people diagnosed through screening programs (rather than through symptoms) show similar bone thinning to symptomatic patients. This means that even if your celiac disease never caused obvious digestive problems, your bones may still be affected.
Why Diagnosis Age Matters
Bone density peaks in your late twenties to early thirties. If celiac disease goes undiagnosed through childhood and adolescence, it can prevent you from ever reaching your full peak bone mass. Children and teens with untreated celiac disease have markedly reduced bone measurements compared to healthy youth, regardless of whether they have obvious symptoms. Starting from a lower peak means you enter the natural bone-loss years of middle age and beyond with less reserve, making osteoporosis more likely and more severe.
How a Gluten-Free Diet Helps Bones Recover
The good news is that bone density does improve on a strict gluten-free diet. The pattern is consistent across studies: the biggest gains happen in the first year, with partial recovery visible by 12 months. Full recovery, however, typically takes up to five years. One well-documented case showed an 81% increase in spine bone density and a 60% increase at the hip over three years, with a plateau around year four.
Vitamin D levels follow a similar trajectory. The prevalence of deficiency drops from 68% at diagnosis to about 54% after one year on a gluten-free diet, then falls to just 8% after five years. As the intestinal lining heals, calcium absorption improves naturally, which is the primary driver of bone rebuilding. This healing makes calcium supplementation less critical over time, though some patients still need it in the early years.
That said, about 25 to 28% of treated celiac patients still have low vitamin D even after being on a gluten-free diet, so ongoing monitoring matters. Compliance with the diet is crucial. Even small amounts of gluten can sustain intestinal damage and keep the malabsorption cycle going.
Bone Density Screening After Diagnosis
A DXA scan (the standard bone density test) at the time of celiac diagnosis catches the widest net of bone problems. A 2025 study evaluating screening strategies found that scanning at diagnosis maximizes early detection of low bone mass. However, the study also found that using fracture risk assessment tools could allow up to 67% of patients to skip the scan entirely, with only a 0.5% chance of missing someone who needed treatment. The tradeoff is that this approach would also miss about 16% of patients with low bone density for their age.
If you’ve just been diagnosed with celiac disease, asking about a bone density scan is reasonable, especially if you’re over 30, went years without a diagnosis, or have other risk factors like a family history of osteoporosis, low body weight, or smoking. For those diagnosed as children or young adults, strict dietary compliance through the bone-building years is the single most important thing you can do to protect your skeleton long-term.