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Can undiagnosed celiac disease put you at risk for bone stress injuries?

Bone stress injuries are common among runners, particularly females. There are many possible reasons they might occur, but recent research has determined that undiagnosed celiac disease could put affected runners at a higher risk for these types of injuries. While the portion of the population with celiac disease remains very small, it may be an important consideration for some runners when evaluating their injury risk.

Prevalence of celiac disease

The study, which was published in the Clinical Journal of Sport Medicine, tested 85 runners for celiac disease using Anti-tissue transglutaminase antibody (TTG) testing. Two participants already had pre-existing celiac disease and three more were confirmed to have celiac disease following an endoscopic biopsy.

In total, approximately five per cent of the group were confirmed to have celiac disease, which is five per cent higher than Canadian population estimates, according to the Canadian Digestive Health Foundation. It’s worth noting, however, that experts believe about 90 per cent of cases go undiagnosed.

There was one thing every runner in this study had in common: they all had a bone stress injury. When left untreated, celiac disease can damage the small intestine, which leads to poor absorption of vitamins and minerals that are important for bone health, like calcium and vitamin D. This, ultimately, could put someone at an increased risk for injuries like stress fractures.

Of course, it’s difficult to definitively say that the patients with celiac disease were at greater risk because of their condition, but considering that this population had a five times greater prevalence of celiac disease than the general population, it is possible that there could be a correlation. This lead the researchers to conclude that “anti-tissue transglutaminase antibody screening for CD should be considered in all patients presenting with BSIs (bone stress injuries).”

What should runners do?

If you’re generally healthy and aren’t presenting with any of the symptoms of celiac disease (like diarrhea, fatigue, weight loss, bloating and anemia), it’s unlikely you have the condition. If you do frequently struggle with one or more of those symptoms, it’s worth looking into, not only to help prevent stress fractures, but several other health problems as well.