Article

Coeliac disease and the risk of fractures - A general population-based cohort study

Harvard University, Cambridge, Massachusetts, United States
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.73). 03/2007; 25(3):273-85. DOI: 10.1111/j.1365-2036.2006.03203.x
Source: PubMed

ABSTRACT

Earlier studies have suggested that untreated coeliac disease may be associated with osteoporosis, but results are contradictory for the risk of long-term fractures.
To study the association between coeliac disease and fractures.
We used Cox regresson to examine the future risk of hip fracture and fracture of any type in more than 13 000 individuals with coeliac disease and 65 000 age- and sex-matched reference individuals in a general population-based cohort.
During follow-up, 1365 first hip fractures and 4847 fractures of any type occurred. Coeliac disease was positively associated with subsequent hip fracture (hazard ratio = 2.1; 95% CI = 1.8-2.4) (in children: hazard ratio = 2.6; 95% CI = 1.1-6.2) and fractures of any type (hazard ratio = 1.4; 95% CI = 1.3-1.5) (in children: hazard ratio = 1.1; 95% CI = 1.0-1.2). The absolute excess risk of hip fractures in children with coeliac disease was 4/100 000 person-years. Incidence ratios for hip fracture in individuals with CD were around two both prior to diagnosis of coeliac disease and afterwards; this risk increase remained 20 years after diagnosis of coeliac disease.
Individuals with coeliac disease, including children with coeliac disease, may be at increased risk of hip fracture and fracture of any type. Coeliac disease may be positively associated with long-term hip fracture risk.

Download full-text

Full-text

Available from: Karl Michaëlsson, Sep 24, 2014
  • Source
    • "In such context, former studies have shown that the distal radius is the most common fractured site corresponding to more than 50% of events in CD cases [10] [11] [12] [13] [14]. Although controversial, some studies suggest that the increased risk can be reverted by strict adherence to a specific treatment, the gluten-free diet (GFD) [11] [12] [15]. Bone health, characterized by its mass, density, and microarchitectural and material properties, is maintained by a balanced system of remodeling [9] [16] [17]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with active celiac disease (CD) are more likely to have osteoporosis and increased risk of fractures. High-resolution peripheral quantitative computed tomography (HR-pQCT) permits three-dimensional exploration of bone microarchitectural characteristics measuring separately cortical and trabecular compartments, and giving a more profound insight into bone disease pathophysiology and fracture .We aimed to determine the volumetric and microarchitectural characteristics of peripheral bones - distal radius and tibia- in an adult premenopausal cohort with active CD assessed at diagnosis. We prospectively enrolled 31 consecutive premenopausal women with newly diagnosed CD (median age 29 years, range: 18-49) and 22 healthy women of similar age (median age 30 years, range 21-41) and body mass index. Compared with controls, peripheral bones of CD patients were significantly lower in terms of total volumetric density mg/cm(3) (mean ± SD: 274.7 ± 51.7 vs. 324.7 ± 45.8, p 0.0006 at the radius; 264.4 ± 48.7 vs. 307 ± 40.7, p 0.002 at the tibia), trabecular density mg/cm(3) (118.6 ± 31.5 vs. 161.9 ± 33.6, p < 0.0001 at the radius; 127.9 ± 28.7 vs. 157.6 ± 15.6, p < 0.0001 at the tibia); bone volume/trabecular volume ratio % (9.9 ± 2.6 vs. 13.5 ± 2.8, p < 0.0001 at the radius; 10.6 ± 2.4 vs. 13.1 ± 1.3, p < 0.0001 at the tibia); number of trabeculae 1/mm (1.69 ± 0.27 vs. 1.89 ± 0.26, p 0.009 at the radius; 1.53 ± 0.32 vs. 1.80 ± 0.26, p 0.002 at the tibia); and trabecular thickness mm (0.058 ± 0.010 vs. 0.071 ± 0.008, p < 0.0001 at the radius with no significant difference at the tibia). Cortical density was significantly lower in both regions (D comp mg/cm(3) 860 ± 57.2 vs. 893.9 ± 43, p 0.02; 902.7 ±48.7 vs. 932.6 ±32.6, p 0.01 in radius and tibia respectively). Although cortical thickness was lower in CD patients, it failed to show any significant inter-group difference (a -8% decay with p 0.11 in both bones). Patients with symptomatic CD (n =22) had a greater bone microarchitectural deficit than those with subclinical CD. HR-pQCT was used to successfully identify significant deterioration in the microarchitecture of trabecular and cortical compartments of peripheral bones. Impairment was characterized by lower trabecular number and thickness- which increased trabecular network heterogeneity- and lower cortical density and thickness. In the prospective follow-up of this group of patients we expect to be able to assess whether bone microarchitecture recovers and to what extend after gluten-free diet. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Mar 2015 · Bone
  • Source
    • "In such context, former studies have shown that the distal radius is the most common fractured site corresponding to more than 50% of events in CD cases [10] [11] [12] [13] [14]. Although controversial, some studies suggest that the increased risk can be reverted by strict adherence to a specific treatment, the gluten-free diet (GFD) [11] [12] [15]. Bone health, characterized by its mass, density, and microarchitectural and material properties, is maintained by a balanced system of remodeling [9] [16] [17]. "

    Full-text · Article · Jul 2014 · Journal of Clinical Densitometry
  • Source
    • "However, the prevalence of fractures in patients with CD (low bone mineral density, BMD) is controversial. Various case control studies and population based surveys have presented contrasting evidence about the risk for fractures in CD patients678910. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background & objectives: The symptoms of celiac disease (CD) are varied and metabolic bone disease (MBD) is less recognized amongst all manifestations in CD patients. Bone disease in CD is attributed to secondary hyperparathyroidism, which in turn is associated with increased bone remodelling. Improvement in bone mineral density (BMD) with gluten free diet (GFD) is known, but the data on efficacy of bisphosphonates in CD patients are limited. Bisphosphonates being a potent inhibitor of bone resorption may be useful in patients with CD having low BMD. The aim of the present investigation was to study the effect of zoledronic acid on BMD in CD patients. Methods: A total of 28 CD patients were randomized to receive GFD, calcium and cholecalciferol (group A), and zoledronic acid (group B). Baseline biochemical tests and T-score by dual energy x-ray absorptiometer were done and repeated after 12 months. Results: The T-score showed improvement in the control arm (group A) from -3.31 ± 1.46 to -2.12 ± 1.44, a gain of 35.9 per cent (P<0.05) and in drug arm (group B) -2.82 ± 1.27 to -1.06 ± 1.84, registering a gain of 62.4 per cent (P<0.001). However, there was no difference in improvement of T-score in zoledronic acid group as compared to the control group. Interpretation & conclusions: Administration of zoledronic acid was not found to be better than GFD alone in increasing BMD in CD patients with low BMD in this pilot study.
    Full-text · Article · Dec 2013 · The Indian Journal of Medical Research
Show more