Emphasizing Bone Health Screening in GI, With Alexandria Markley, MD

Despite the known importance of bone health screening in patients with celiac disease (CeD) and inflammatory bowel disease (IBD), new research suggests overall rates of bone mineral density (BMD) and osteoporosis screening in these populations are low.1

The data were presented at the American College of Gastroenterology (ACG)’s 2025 Annual Scientific Meeting by Alexandria Markley, MD, a resident physician at Icahn School of Medicine at Mount Sinai, and highlight the need for optimized screening practices in patients with chronic GI diseases in order to reduce fracture risk and improve long-term outcomes.1

“Patients have this chronic inflammation, sometimes medication use, and malabsorptive qualities to their disease, so sort of the perfect storm. It's super important to identify early on to potentially prevent any sort of fracture in the future,” Markley explained to HCPLive.

Current guidelines from the US Preventive Services Task Force recommend screening for osteoporosis to prevent osteoporotic fractures in women ≥ 65 years of age and in postmenopausal women ≤ 65 years of age who are at increased risk for an osteoporotic fracture. However, Markley notes the need for additional screening efforts in patients with CeD and IBD, which are described in disease-specific guidelines but often fall short in clinical practice.2

To characterize screening practices in these patient populations, Markley and colleagues conducted a retrospective chart review of patients with CeD, IBD, or both, who received care at a tertiary care center. They collected data on demographics, diagnosis type, and dual-energy X-ray absorptiometry (DEXA) scan history. The primary outcomes were DEXA screening rates and prevalence of osteoporosis and osteopenia among those screened.1

A total of 336 patients were included in the study (n = 84 per group). Investigators noted mean age differed significantly between the groups (P = .0004), with ulcerative colitis (UC) patients being the oldest (mean age, 43.3 years) and those with a dual diagnosis of CeD and IBD being the youngest (mean age, 32.2 years). Sex distribution also varied (P = .005), with Crohn disease (CD) and UC groups having more males (56% and 54%), and CeD and CeD/IBD groups having more females (68% and 60%). BMI differed by group (P = .0008), with the CeD group exhibiting the highest mean BMI (24.3) and the CD group the lowest (21.1).1

Investigators noted overall DEXA screening rates were low, ranging from 14% to 32%, with significant differences between groups (P = .0038). Patients with CeD were more likely to have screening compared to those with IBD or a dual diagnosis. Among those screened, rates of decreased bone mineral density were comparable between the CeD cohort (48%) and dual diagnosis CeD/IBD cohort (46%; P = .92).1

“Our study shows that we're not doing a great job of screening these patients in the first place, and when we are screening them, we have found that nearly 50% of these patients had low bone marrow density,” Markley explained. “This is a high risk group at baseline, and we are not doing that great of a job of identifying these patients to hopefully intervene on the earlier side.”

Editors’ note: Markley has no relevant disclosures.

References

1. Markley A. Rodriguez LR, Patel S, et al. Osteoporosis Screening in Patients with Celiac Disease, Inflammatory Bowel Disease, and Dual Diagnosis: A Retrospective Chart Review. Presented at the American College of Gastroenterology (ACG)’s 2025 Annual Scientific Meeting. Phoenix, Arizona. October 27-29, 2025.

2. US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2025;333(6):498–508. doi:10.1001/jama.2024.27154