Clinical trials and cross-sectional studies have reported reduced bone mineral content and bone mineral density in untreated children, adolescents and adults with celiac disease; both of these parameters improve significantly with compliance to a gluten-free dietary pattern for at least 1 year.  Compliance with dietary treatment initiated during childhood or adolescence allows achievement of a normal bone mineralization.  However, studies in untreated adults have shown that a gluten-free dietary pattern improves but may not normalize bone mineral density; successful treatment depends on the age at diagnosis, as patients who do not receive treatment in childhood and adolescence may never reach peak bone mass.  Further studies are needed regarding the effects of calcium and vitamin D supplementation on bone mineral content and bone mineral density, as well as hormone replacement therapy for postmenopausal women. 

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• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
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