Table 1.

The scenarios for CeD screening in individuals having fragility fracture or low BMD.

1	Vitamin D deficiency, elevated parathyroid hormone or low urinary calcium level despite sufficient vitamin D and calcium intake *.
2	When there is an inadequate response to therapy with oral bisphosphonates
3	The presence of medical conditions having a clear risk of possible celiac disease development: Autoimmune disorders of the thyroid gland and liver diseases Dermatitis herpetiformis † Type 1 diabetes mellitus Down syndrome Persistent unexplained steatorrhea after upper gastrointestinal surgeries
4	The presence of any symptoms suggestive of celiac disease Gastrointestinal symptoms Chronic non-bloody diarrhea † Signs and laboratory findings of malabsorption † An otherwise unexplainable weight loss † Iron deficiency with or without anemia without evident blood loss †

* Adequate daily vitamin D and calcium intake (see text for recommended daily allowance). ^† Patients with these conditions, symptoms, or signs should have histological examination of duodenal biopsy regardless of the results of celiac disease serologic testing. CeD, celiac disease; BMD, bone mineral density.