• coeliac disease
• osteoporosis
• bone fracture

Metabolic bone disease is a well established complication of coeliac disease. Early reports focused mainly on the association with vitamin D deficiency and osteomalacia¹ but more recently attention has turned to osteoporosis.² A number of studies have demonstrated reduced bone mineral density in individuals with coeliac disease, particularly in untreated cases and in those who fail to respond fully to a gluten free diet.³ Furthermore, the need to consider coeliac disease as a pathogenetic factor in individuals presenting with osteoporosis has been emphasised; this particularly applies to those with clinical features of the disease and those who fail to respond to treatment for their osteoporosis.

The clinical significance of the observed reduction in bone mineral density associated with coeliac disease is unclear. While a small proportion of patients undoubtedly develop severe osteoporosis with multiple fragility fractures, the question of whether fracture risk is significantly increased across the clinical spectrum of coeliac disease has only recently been explored. Studies in small numbers of selected patients, drawn from hospital clinics, have suggested that fracture risk is increased^4, …