Musculoskeletal consequences of coeliac disease

Coeliac disease is no longer confined to the gastrointestinal tract. Increasing evidence has positioned it as a systemic condition with profound implications for bone, muscle, and joint health. Yet, the musculoskeletal consequences of coeliac disease remain largely under-recognised, underdiagnosed, and undertreated. This narrative review critically explores the multifaceted pathophysiology linking gluten sensitivity to skeletal fragility, sarcopenia, and autoimmune arthropathies, integrating findings from paediatric to elderly populations. Nutritional deficiencies, chronic inflammation, immune dysregulation, and alterations in gut microbiota emerge as central contributors to musculoskeletal decline. Clinical evidence highlights increased fracture risk, early-onset osteoporosis, muscle wasting, and functional impairment, even in asymptomatic individuals or those with potential coeliac disease. Diagnostic and therapeutic strategies require a multidisciplinary approach that combines gluten exclusion, biomarker surveillance, physical rehabilitation, and targeted nutritional support. By unveiling the often-overlooked musculoskeletal burden of coeliac disease, this review calls for broader clinical awareness and a re-evaluation of management priorities in both gastroenterology and musculoskeletal medicine.