Excess non-spine fractures in women over 50 years with celiac disease: A cross-sectional, questionnaire-based study

Abstract

The association of celiac disease with fracture is controversial. Recent studies may have underestimated the impact by studying patients with low fracture risk. Since postmenopausal women are at greatest risk of fracture, we have investigated non-spine fracture occurrence in women > or =50 years with celiac disease. Patients were recruited from hospital and general practice as well as from volunteers, controls from general practice. All completed a questionnaire detailing fracture occurrence. Three hundred and eighty-three female celiac patients and 445 female controls aged > or =50 years at time of study were compared. Mean age was 61.4+/-7.8 years in celiac patients and 62.7+/-9.9 years in controls. Celiac patients were lighter but not shorter. Celiac patients displayed greater "all fracture" prevalence (odds ratio [OR], 1.51; confidence interval [CI], 1.13:2.02) and fracture after 50 years (OR, 2.20; CI, 1.49:3.25). Wrist fracture was more frequent (OR, 1.65; CI, 1.12:2.41), but significance was lost once height and weight were taken into account. Celiac patients had more multiple fractures (OR, 2.96; CI, 1.81:4.83). To investigate the association of fracture with time from diagnosis, 324 celiac patients were paired with a control by age. No excess fracture risk was found more than 10 years before diagnosis amongst celiac patients diagnosed after age 50 years, but risk increased in the period from 10 years before diagnosis to 5 years after and remained high more than 5 years after diagnosis ( p<0.05). Wrist fracture only increased in the period more than 5 years after diagnosis ( p<0.05). In women diagnosed before 50 years, no excess fracture risk existed. Fracture risk in female celiac patients >50 years is increased overall but is related largely to the peri-diagnostic period. Wrist fracture risk is partly accounted for by height and weight, but is more common more than 5 years after diagnosis. Celiac testing may be indicated in thin women over 50 years with multiple fractures, and after diagnosis adequate calcium and vitamin D intake should be ensured.

Celiac Disease and Bone Fractures: A Systematic Review and Meta-Analysis

“…15 studies fulfilled the inclusion criteria (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In addition, one relevant publication was identified from the reference lists of the reviewed articles (21). Of the relevant publications, seven (15)(16)(17)(18)(19)(20)(21) had been included in a previous systematic review and meta-analysis by Olmos and colleagues.…”

“…20 potentially relevant abstracts were identified and full-text versions obtained. Of these, six (11,12,16,18,21,22) were excluded as they were conference abstracts describing a study of which also a full text paper was published. In these cases, we excluded the conference abstract and included the full text paper in our systematic review.…”

“…In addition, one relevant publication was identified from the reference lists of the reviewed articles (21). Of the relevant publications, seven (15)(16)(17)(18)(19)(20)(21) had been included in a previous systematic review and meta-analysis by Olmos and colleagues. Four articles (7,10,11,13) were also identified when we updated Olmos and colleagues' search.…”

“…In all, 16 studies were included in the systematic review (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)23) and 14 of these in the meta-analyses (8 -12, 14 -21, 23). Two studies were excluded from the meta-analysis due to a different exposure (unrecognised celiac disease) (7,13).…”

Celiac Disease and Osteoporosis: A Review

“…Moreno et al [20] studied all fractures (osteoporotic and nonosteoporotic), with an increase of 7% although the quality of the study was reduced due to the discordance between cases (14) and controls (296). A case-control study of post-menopausal women aged older 50 years included 383 celiac patients and 445 controls and found an increased risk of fractures in celiac patients (OR 1.51;95% CI 1.13-2.02) [21]. Only Thomason et al [22] who analyzed different types of fractures (previous fractures, all fractures, low intensity fractures and Colles fractures) in 274 celiac patients and 224 controls did not find significant differences.…”