Should patients with coeliac disease have their bone mineral density measured?
BACKGROUND
In 1998 we published guidelines for managing osteoporosis in coeliac disease. These guidelines recommended bone mineral density (BMD) measurement at diagnosis. We analyse the results of following these guidelines in a district general hospital with a view to rationalizing screening.


METHODS
Forty-three consecutive patients with newly diagnosed coeliac disease had dual-energy X-ray absorptiometry scans of the hip and lumbar spine. Results were correlated with factors that were suspected to influence BMD and were compared with comparable published studies.


RESULTS
Osteoporosis at the hip and spine was found in only 7% and 14% of patients, respectively. Mean z scores were not significantly reduced. BMD did not correlate with the duration of gluten exposure, symptoms, degree of villous atrophy, or smoking. At the hip, but not at the spine, there was a significant correlation between BMD and the body mass index.


CONCLUSIONS
The surprisingly low yield of reduced BMD, together with doubt about increased fracture rates in coeliac patients, does not support the current recommendations for screening BMD at diagnosis, and the guidelines should be changed.
Lewis
Nina R
NR
Department of Medicine, Lincoln County Hospital, Lincoln, UK.
Scott
Brian B
BB
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015519:Bone Density; D002446:Celiac Disease / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D005983:Glutens / Q000008:administration & dosage; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects
D005983:Glutens