Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease

Awareness of surroundings, mobility, and eyesight collectively contribute to a tendency to fall and all are likely to be important. 6 Furthermore, bone strength is largely related to trabecular structure, certainly in the proximal femur, whereas BMD is a composite measurement of both cortical and trabecular bone. 7 Although the population can be stratified for fracture risk using BMD measurements, its poor sensitivity for predicting actual fracture makes it unsuitable for screening the whole population or even all post-menopausal women-the difficulties and costs are great and it would have only a small contribution to fracture prevention in the community as a whole. 3 8-10 The alternative is to target certain high risk groups for screening or treatment, or both. 2.3 METHODS OF MEASURING BONE MINERAL DENSITY There are several methods available for measuring BMD. 11 Dual energy x ray absorptiometry (DEXA) is currently most favoured, but is relatively costly and is not widely available; roughly 100 instruments have been installed in the UK. In some men there may be loss of gonadal function 27 which may, as in women, contribute to osteoporosis. 28 Unfortunately, serum testosterone concentrations are unlikely to be helpful in planning testosterone replacement therapy because the concentrations tend to be high, especially before treatment, owing to androgen resistance. 27 There seems to be impairment of peripheral reduction of testosterone to the active dihydrotestosterone. 27 4.0 Inflammatory bowel disease 4.\n 80 Although this is logical, the combination has not been studied. 6.8.4 Bone mineral density threshold for treatment There is no direct evidence on which to base a threshold of BMD for giving a bisphosphonate.