title: Approach to diagnosing celiac disease in patients with low bone mineral density or fragility fractures: multidisciplinary task force report.
abstract: OBJECTIVE
  To provide clinicians with an update on the diagnosis of celiac disease (CD) and to make recommendations on the indications to screen for CD in patients presenting with low bone mineral density (BMD) or fragility fractures.
  
  
  METHODS
  A multidisciplinary task force developed clinically relevant questions related to the diagnosis of CD as the basis for a literature search of the MEDLINE, EMBASE, and CENTRAL databases (January 2000 to January 2009) using the key words celiac disease, osteoporosis, osteopenia, low bone mass, and fracture. The existing literature consists of level I and II studies.
  
  
  RESULTS
  The estimated prevalence of asymptomatic CD is 2% to 3% in individuals with low BMD. Routine screening for CD is not justified in patients with low BMD. However, targeted screening for CD is recommended for patients who have T-scores of -1.0 or less at the spine or hip, or a history of fragility fractures in association with any CD-related symptoms or conditions; family history of CD; or low urinary calcium levels, vitamin D insufficiency, and raised parathyroid hormone levels despite adequate intake of calcium and vitamin D. Celiac disease testing should be performed while the subject is consuming a gluten-containing diet; initial screening should be performed with human recombinant immunoglobulin (Ig) A tissue transglutaminase or other IgA tissue transglutaminase assays, in association with IgA endomysial antibody immunofluorescence. Duodenal biopsy is necessary to confirm the diagnosis of CD. Human leukocyte antigen typing might assist in confirming or ruling out the diagnosis of CD in cases where serology and histology are discordant. Definitive diagnosis is based on clinical, serologic, and histologic features, combined with a positive response to a gluten-free diet.
  
  
  CONCLUSIONS
  Current evidence does not support routine screening for CD in all patients with low BMD. A targeted case-finding approach is appropriate for patients who are at higher risk of CD.
authors.affiliation: 331-209 Sheddon Ave, Oakville, ON L6J 18X. draliyakhan@gmail.com.
authors.forename: Lorena P
authors.initials: LP
authors.lastname: Rios
authors.forename: Aliya
authors.initials: A
authors.lastname: Khan
authors.forename: Muhammad
authors.initials: M
authors.lastname: Sultan
authors.forename: Karen
authors.initials: K
authors.lastname: McAssey
authors.forename: Mona A
authors.initials: MA
authors.lastname: Fouda
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
mesh_terms: D000465:Algorithms; D058070:Asymptomatic Diseases; D001851:Bone Diseases, Metabolic / Q000209:etiology; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis*; D003661:Decision Support Techniques; D006801:Humans; D010024:Osteoporosis / Q000209:etiology*; D058866:Osteoporotic Fractures / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors