Celiac Disease Tied to Increased Risk of Major Osteoporotic Fractures

By Lisa Rapaport

September 16, 2020

(Reuters Health) - Celiac disease is associated with major osteoporotic fracture independent of fracture risk assessment tool (FRAX) score, a Canadian study in Osteoporosis International suggests.

For the study, researchers examined data on from the Manitoba Bone Mineral Density Registry to calculate the 10-year risk of major osteoporotic fractures in 693 individuals with celiac disease who were followed for a mean of 7.0 years and 68,037 general population subjects who were followed for a mean of 7.1 years.

During the study, the proportion of people in each cohort who experienced one or more major osteoporotic fractures was the same - 8.4% -- even though the celiac disease group was younger, with a greater proportion of men.

In the general population, there was good agreement between FRAX predicted and observed 10-year major osteoporotic fracture probability. In patients with celiac disease, however, predicted and observed fracture probabilities did not match unless celiac disease was considered as secondary osteoporosis; otherwise, FRAX underestimated the celiac patients' 10-year major fracture risk (7.4% predicted vs 10.8% observed).

Accounting for BMD at the femoral neck also improved the ability of FRAX to predict fractures in the celiac group.

"This study demonstrates that when celiac disease is considered a secondary risk factor for osteoporosis, it accurately predicts fracture risk in individuals with celiac disease," said lead study author Dr. Donald Duerksen, an associate professor of medicine at the University of Manitoba in Winnipeg, Canada.

"Therefore, this study has demonstrated that FRAX can be used to estimate fracture risk in an individual with celiac disease," Dr. Duerksen said by email.

Among the people with celiac disease in the study, each 1-standard deviation increase in FRAX score was associated with a higher risk of major osteoporotic fracture, whether calculated with secondary osteoporosis (HR 1.66) or bone mineral density (HR 1.80).

One limitation of the study is that men were underrepresented in the BMD registry database. Another drawback is that researchers lacked data on dietary factors that might impact the fracture risk including calcium and vitamin D intake. They also lacked data on how closely people with celiac disease adhered to a gluten-free diet, which has been linked to improved bone mineral density.

"Some patients may have followed the (gluten-free) diet whereas others may not have followed the diet, and this may have affected the results of the study," said Dr. Aliya Khan, director of the Calcium Disorders Clinic at McMaster University in Ontario, Canada.

Patients with celiac disease should be evaluated for bone health and also have lab tests to ensure that serum calcium, phosphate and vitamin D levels are normal, Dr. Khan, who wasn't involved in the study, said by email.

"Any abnormalities in the lab profile should be corrected, and it is important to emphasize strict adherence to the gluten free diet as this will enhance absorption of key nutrients and this in turn is expected to improve bone quality and strength," Dr. Khan said.

SOURCE: https://bit.ly/32vNm3g Osteoporosis International, online August 3, 2020.

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