Celiac disease and osteoporosis

The recently published “ASHP Therapeutic Position Statement on the Prevention and Treatment of Osteoporosis in Adults” is a well-written, comprehensive review of a very important disease.1 I respectfully suggest that the document should have included a discussion of the important relationship between celiac disease and osteoporosis. Approximately 1% of the U.S. population has celiac disease.2 Although the diagnosis of this disease has increased in recent years, the majority of affected patients remain undiagnosed. It is particularly noteworthy that approximately 75% of patients with newly diagnosed celiac disease have some degree of bone loss, and up to 35% of newly diagnosed adults have established osteoporosis. Low bone density affects both men and women with celiac disease, but men tend to suffer more severe osteoporosis than do women.3 The high rate of osteoporosis in both men and women with celiac disease has led experts to recommend that all patients with celiac disease be screened for osteoporosis.4 Some researchers have also suggested that the frequency of celiac disease in osteoporosis is so high that serologic screening for celiac disease is indicated for all patients with osteoporosis.5