Optimising the Management of Bone Disease for Coeliac Patients in a Dietetic-led Clinic

Coeliac disease (CD) is a chronic autoimmune inflammatory condition of the small bowel; the only treatment is lifelong adherence to a gluten free diet (GFD). Adherence to a GFD also minimises the risk of associated conditions such as osteoporosis in CD patients. The present study aimed to evaluate and optimise management of bone disease in CD patients in a dietetic-led clinic. This study was conducted in two parts: study 1 utilised retrospective data to evaluate management of bone disease with reference to British Society of Gastroenterology (BSG) guidelines in 229 CD patients. Based on the results from study 1, study 2 developed a tool to estimate dietary calcium intake in CD patients, which was then trialled on 50 patients. There were no significant differences between the population demographics for study 1 and study 2. 65% of patients had a diagnosis of osteopenia or osteoporosis, in a female predominant population (74.6%). Reported mean dietary calcium intake was over estimated at 1239.6mg/day (SD ± 377.1mg) in study 1 and corrected to 852mg/day (SD ± 264.57mg) using improved methodology (study 2) (p?0.05). Understanding and compliance with dietary advice correlated positively with GFD (p?0.001) but not osteoporosis or fracture risk. Overall patients attending the clinic did not meet the BSG recommended calcium intake. However, 30% of patients could meet the 2014 BSG target from oral diet alone. Utilising individual dietary prescriptions and targeted use of calcium supplementation maximised the opportunity to reduce risk of bone disease and improved compliance with BSG recommendations.