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We agree that the risk of fracture in coeliac disease needs to be estimated more precisely and that judicious use of DEXA scanning is appropriate in this group, as it is in the general population. However, as Walters and colleagues (
) and others have clearly shown, bone mineral density does improve following treatment with a gluten free diet, so recommendations to screen all newly diagnosed patients with coeliac disease at diagnosis do not seem judicious.1
Larger studies are needed and one such is in progress. Nevertheless, the small increases in risk which we found are similar to those found in the only other population based study of fracture risk in patients with coeliac disease.2 In the absence of robust data showing a marked increase in the risk of fracture in patients with coeliac disease, perhaps the onus should be on those making such recommendations1 to provide evidence supporting their efficacy and cost effectiveness.
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