Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County, Minnesota

• Published in: Digestive diseases and sciences Vol. 53; no. 4; pp. 964 - 971
• Main Authors: Jafri, Mohammed R., Nordstrom, Charles W., Murray, Joseph A., Van Dyke, Carol T., Dierkhising, Ross A., Zinsmeister, Alan R., Melton, Lee J.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.04.2008; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Biochemistry; Biological and medical sciences; Case-Control Studies; Celiac disease; Celiac Disease - complications; Celiac Disease - diagnosis; Celiac Disease - therapy; Child; Child, Preschool; Cohort Studies; Feeding. Feeding behavior; Female; Fractures, Bone - epidemiology; Fundamental and applied biological sciences. Psychology; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatology; Humans; Infant; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Minnesota; Oncology; Original Paper; Other diseases. Semiology; Risk Assessment; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Transplant Surgery; Traumas. Diseases due to physical agents; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Minnesota; United States; North America; America; Osteoporosis; Sprue; Fractures; Osteomalacia; Outcome; Human; Immunopathology; Prognosis; Diseases of the osteoarticular system; Nutrition disorder; Vitamin deficiency; Metabolic diseases; Fracture; Coeliac disease; Trauma; Long term; Vitamin D; Intestinal malabsorption; Risk factor; Gastroenterology; Digestive diseases; Intestinal disease; Nutritional status
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-007-9976-0

Celiac disease is associated with decreased bone density, but there are conflicting data regarding fracture risk. We determined the fracture incidence relative to matched controls in a population-based cohort with celiac disease before and after diagnosis. Olmsted County residents with celiac disease ( n  = 83) diagnosed between 1950 and 2002 were compared with 166 gender and age matched controls. Fracture histories were ascertained from each subject’s medical records. Celiac disease is linked to an increased fracture risk before and after diagnosis. Before the index date, cases had a fracture rate twice that of controls (CI: 1.0–3.9, P  = 0.045) and 2.5-fold greater after the index date (CI: 1.1–5.6, P  = 0.026). Appendicular and axial fractures were 2.5 (CI: 0.9–6.5) and 3.2 times more likely (CI: 1.0–10.5) after the index date. These observations support a rationale for earlier detection of celiac disease, and active management of bone disease before bone effects have occurred, to reduce the persistent risk of fractures.