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. 2011 Jul 7;17(25):3035-42.
doi: 10.3748/wjg.v17.i25.3035.

Risk of fracture in celiac disease: gender, dietary compliance, or both?

María Inés Pinto Sánchez  1 , Adriana Mohaidle, Andrea Baistrocchi, Dolores Matoso, Horacio Vázquez, Andrea González, Roberto Mazure, Evangelina Maffei, Guillermina Ferrari, Edgardo Smecuol, Adriana Crivelli, Juan Andrés de Paula, Juan C Gómez, Silvia Pedreira, Eduardo Mauriño, Julio César Bai
Affiliations

Risk of fracture in celiac disease: gender, dietary compliance, or both?

María Inés Pinto Sánchez et al. World J Gastroenterol. .

Abstract

Aim: To determine the incidence of peripheral fractures in patients with celiac disease (CD) and the effect of treatment on fracture risk.

Methods: We compared the incidence and risk of peripheral fractures before and after diagnosis between a cohort of 265 patients who had been diagnosed with CD at least 5 years before study entry and a cohort of 530 age- and sex-matched controls who had been diagnosed with functional gastrointestinal disorders. Data were collected through in-person interviews with an investigator. The overall assessment window for patients was 9843 patient-years (2815 patient-years after diagnosis).

Results: Compared with the control group, the CD cohort showed significantly higher incidence rate and risk of first peripheral fracture before diagnosis [adjusted hazard ratio (HR): 1.78, 95% CI: 1.23-2.56, P < 0.002] and in men (HR: 2.67, 95% CI: 1.37-5.22, P < 0.004). Fracture risk was significantly associated with the classic CD presentation with gastrointestinal symptoms (P < 0.003). In the time period after diagnosis, the risk of fractures was comparable between the CD cohort and controls in both sexes (HR: 1.08, 95% CI: 0.55-2.10 for women; HR: 1.57, 95% CI: 0.57-4.26 for men).

Conclusion: CD patients have higher prevalence of fractures in the peripheral skeleton before diagnosis. This is associated with male sex and classic clinical presentation. The fracture risk was reduced after the treatment.

Keywords: Celiac disease; Fracture risk; Gluten-free diet; Peripheral fractures; Sex difference.

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Figures

Figure 1
Figure 1
Kaplan-Meier curves of time to first fracture for patients according to clinical presentation in celiac disease patients and matched control population before the time of celiac disease diagnosis. A : Classic presentation celiac disease (CD) patients; B: Atypical/silent presentation CD patients. HR: Hazard ratio; NS: Not significant.
Figure 2
Figure 2
Kaplan-Meier curves showing time of first fracture according to gender in celiac disease population versus control group. A: Females before diagnosis; B: Males before diagnosis; C: Females after diagnosis; D: Males after diagnosis. CD: Celiac disease; HR: Hazard ratio; NS: Not significant.
See this image and copyright information in PMC

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