In their article reviewing recent advances in coeliac disease (Gut 2006;55:1037–46), the authors discuss the impact of clinically diagnosed coeliac disease, including the two most recognised complications of osteoporotic fracture and malignancy. Their analysis correctly concludes that there is now reasonably precise information of the actual risks to patients of osteoporosis, lymphoma and other malignancies, but they describe the overall risk of fractures as being “at most moderate”. They miss, however, the opportunity to compare the absolute risks of these complications, which suggest in fact that osteoporosis prevention should remain the principal concern of long-term care in this condition.

The relative and absolute risks of fractures were well described in an important population-based cohort of patients with 4732 disease, using data from the UK General Practice Research Database between 1987 and 2002, by West et al¹ These authors also published data on the risks of malignancy in the same cohort of patients with disease over the same period.² Data from these two papers have been extracted and combined in table 1.

The hazard ratios for fractures are between 1.3 (for any fracture) and 1.9 (hip fracture at any age). The ratios for …