Don’t Overlook Bone Health in Coeliac Disease

TOPLINE:

Patients with coeliac disease commonly have osteoporosis and sustain fractures. The Fracture Risk Assessment Tool (FRAX) may help target bone health testing in this population.

METHODOLOGY: 

• Investigators conducted a retrospective cohort study of 593 adult patients in the United Kingdom with biopsy-confirmed coeliac disease.
• All underwent dual-energy x-ray absorptiometry (DXA) within 1 year of diagnosis and had an assessment of fracture risk with FRAX.
• The main outcome was major osteoporotic fracture.

TAKEAWAY: 

• At baseline, 32.3% of patients had osteopenia and 14.5% had osteoporosis.
• Patients’ odds of osteoporosis increased with age (odds ratio, 1.06; P < .0001) and immunoglobulin A–tissue transglutaminase titre (1.04; P = .03), and decreased with body mass index (0.90; P = .003).
• During a 10.5-year median follow-up, 18.7% of patients sustained a fracture; 54.4% of these were major osteoporotic fractures.
• FRAX had a high specificity (91.3%) and negative predictive value (93.5%) in predicting major osteoporotic fractures.
• Patients were more likely to sustain a fracture if they continued to consume gluten (odds ratio, 1.86; P = .02) or had previously sustained a fracture (2.69; P = .005), and the risk rose with age (1.03; P < .0001).

IN PRACTICE:

“Patients with [coeliac disease] should be made aware of their potentially increased risk for fracture and reduced bone strength, and the importance of adherence to a gluten-free diet should be emphasised in [this] context…,” the authors wrote. “The FRAX tool may have a role in aiding the risk stratification of patients with [coeliac disease]”; more specifically, this tool “may help identify patients at low risk of [major osteoporotic fracture] who are unable or do not wish to undergo DXA investigation,” they added.

SOURCE:

The study was led by Olivia Green, NHS Foundation Trust and University of Sheffield, Sheffield, UK, and was published online in the Scandinavian Journal of Gastroenterology. 

LIMITATIONS:

Limitations included the retrospective study design, self-reporting of some factors (eg, smoking and alcohol intake), and conduct at a single tertiary care centre.

DISCLOSURES:

The study did not receive any funding. The authors reported no conflicts of interest.