Celiac disease (CD) is frequently associated with other autoimmune disorders. Different studies have explored the association between CD and single autoimmune endocrine disease (AED), especially autoimmune thyroiditis (AIT) and type-1 diabetes mellitus (T1DM). Data about CD as a component of autoimmune polyendocrine syndrome (APS) are scant. We analyzed a large dataset including prospectively collected data from 920 consecutive adult CD patients diagnosed in a third-level Italian institution in the 2013–2023 period, The prevalence of isolated autoimmune endocrine diseases and APS were collected. A total of 262 (28.5%) CD patients had at least one associated AED, with AIT (n = 223, 24.2%) and T1DM (n = 27, 2.9%) being the most frequent conditions. In most cases (n = 173, 66%), AEDs were diagnosed after CD. Thirteen patients (1.4%) had at least two of the requested three endocrinopathies, satisfying the diagnosis of APS. APS is a rare but not exceptional occurrence among Italian CD patients, underscoring the intricate and multifaceted nature of autoimmune disorders. Periodic evaluations of thyroid function and glycaemia should be recommended after the diagnosis of CD together with testing for autoantibodies that may be helpful in assessing disease risk before disease onset. Likewise, implementation of a systematic screening for CD amongst T1DM and other autoimmune endocrine diseases are paramount.

INTRODUCTION: Patients with celiac disease (CeD) have an increased risk of osteoporosis and fractures, but the ideal timing for bone mineral density (BMD) assessment remains unclear due to conflicting recommendations. This study evaluated the optimal timing for dual-energy x-ray absorptiometry (DXA) screening considering different clinical targets: early detection of BMD alterations, osteoporosis diagnosis, or fracture risk stratification. METHODS: Observational study prospectively enrolling 627 patients with CeD (>25 years) who underwent DXA scans of the lumbar spine and hip as part of standard care. Data on clinical presentation, serology, histology, and fracture risk were analyzed. Logistic regression identified risk factors of low BMD and osteoporosis. The reliability of the National Osteoporosis Guidelines Group (NOGG) guidelines for avoiding unnecessary DXAs was assessed. RESULTS: Low BMD for age was present in 17.2% of patients, with significant prevalence in the 25–34 years age group (13.4%), further increasing in the 45–54 years age group. Osteoporosis was detected in 17.9% of patients, with prevalence increasing significantly in patients aged older than 45 years. Risk factors included weight loss, underweight status, and iron-deficiency anemia. Using the NOGG criteria, 67% of patients could have avoided DXA, with a 0.5% risk of missing clinically significant findings requiring treatment (but also losing 15.7% patients with low BMD for age). DISCUSSION: The ideal timing for DXA screening in patients with CeD depends on the clinical objective. DXA at diagnosis maximizes the early detection of low bone mass, whereas the NOGG criteria effectively identified patients at high risk of fractures, reducing unnecessary scans. However, their use should be weighed against an underdetection of clinically relevant BMD alterations. Tailoring DXA timing to healthcare resources and patient demographics may optimize outcomes and resource allocation.