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We read with great interest the recently published guidelines on the management of osteoporosis associated with chronic liver disease (
). However, we would like to add a few words of comment. Associations between coeliac disease (CD) and primary biliary cirrhosis in particular and other autoimmune liver diseases in general have been reported.1–3 In addition, it has been suggested that these individuals should be considered as an at risk group for whom serological testing for CD is indicated.1 Patients with CD are at high risk of developing low bone mineral density and bone turnover impairment,1 and it has been shown that adherence to a gluten free diet has a significant positive impact on these parameters.4 Thus we suggest that physicians caring for patients with the above mentioned liver diseases should screen them for CD in the presence of signs and symptoms suggestive of malabsorption such as osteoporosis. This seems a reasonable strategy as detection of CD will allow for a more rational therapeutic approach to the risks determined by this association. Complications due to the presence of CD, such as malnutrition, anaemia, and osteoporosis, may have a considerable impact on liver disease management and the need/success of transplantation.5,6
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