Fracture risk assessment in celiac disease: a registry-based cohort study

• Published in: Osteoporosis international Vol. 32; no. 1; pp. 93 - 99
• Main Authors: Duerksen, D.R., Lix, L.M., Johansson, H., McCloskey, E.V., Harvey, N.C., Kanis, J.A., Leslie, W.D.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.01.2021; Springer Nature B.V
• Subjects: Absorptiometry, Photon; Bone Density; Bone mineral density; Canada - epidemiology; Celiac disease; Celiac Disease - complications; Celiac Disease - epidemiology; Cohort analysis; Cohort Studies; Endocrinology; Fractures; Humans; Incidence; Manitoba; Medicine; Medicine & Public Health; Original Article; Orthopedics; Osteoporosis; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - etiology; Registries; Rheumatology; Risk Assessment; Risk Factors; Canada; Manitoba; Celiac disease; Osteoporosis; FRAX score; Epidemiology; Major osteoporotic fracture risk
• ISSN: 0937-941X; 1433-2965; 1433-2965
• DOI: 10.1007/s00198-020-05579-7

Summary Celiac disease is associated with an increased fracture risk but is not a direct input to the FRAX® calculation. When celiac disease is considered as a secondary osteoporosis risk factor or BMD is included in the FRAX assessment, FRAX accurately predicts fracture risk. Introduction The fracture risk assessment tool (FRAX®) uses clinical factors and bone mineral density (BMD) measurement to predict 10-year major osteoporotic (MOF) fracture probability. The study aim was to determine whether celiac disease affects MOF risk independent of FRAX score. Methods The Manitoba BMD Registry includes clinical data, BMD measurements, 10-year probability of MOF calculated for each individual using the Canadian FRAX tool and diagnosed celiac disease. Using linkage to population-based healthcare databases, we identified incident MOF diagnoses over the next 10 years for celiac disease and general population cohorts. Results Celiac disease ( N  = 693) was associated with increased fracture risk adjusted for FRAX score computed without secondary osteoporosis or BMD (adjusted hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.11–1.86). Celiac disease was no longer a significant risk factor for fracture when secondary osteoporosis or BMD were included in the FRAX calculation ( p  > 0.1). In subjects with celiac disease, each SD increase in FRAX score (calculated with and without secondary osteoporosis or BMD) was associated with higher risk of incident MOF (adjusted HR 1.66 to 1.80), similar to the general population (p-interaction > 0.2). Including celiac disease as secondary osteoporosis or including BMD in FRAX 10-year MOF probability calculations (10.1% and 8.6% respectively) approximated the observed cumulative 10-year MOF probability (10.8%, 95% CI 7.8–13.9%). Conclusions Celiac disease is associated with an increased risk of major osteoporotic fractures. When celiac disease is considered as a secondary osteoporosis risk factor or BMD is included in FRAX assessment, FRAX accurately predicts fracture risk.