Original articleStratification of bone fracture risk in patients with celiac disease☆
Section snippets
Patients
We enrolled 148 unselected consecutive adult patients (117 women; age range, 17–81 years) who fulfilled the standard criteria for diagnosis of CD and who were attending 2 different tertiary referral centers devoted to the diagnosis and follow-up of patients with CD. Diagnosis of classically symptomatic and subclinical CD patients was based on the clinical picture, typical histological findings (in all patients), and a concordant CD-specific serology. For those with negative serology at
Clinical characteristics of patients
A total of 148 CD patients were enrolled in the study: 78 (53%) patients were considered classically symptomatic, 53 (36%) were considered subclinical patients, and 17 (11%) were considered silent cases. Table 1 shows some epidemiological and clinical features of patients and controls at study entry and at the time of diagnosis of CD grouped as classically symptomatic and subclinical/silent cases and their respective controls. Patients with classic symptoms were older than subclinical/silent
Discussion
Recently, our group suggested an increased prevalence of fractures in the peripheral skeleton of CD patients.7 It is interesting to note that these findings in peripheral bones did not extend to the axial skeleton, where a meticulous morphometric analysis of radiographs was used to determine the presence of vertebral deformities (wedge and compression). Although these observations are in concordance with the known increased fracture risk based on densitometric bone mass estimations, some recent
Acknowledgements
The authors thank Christina Surawicz, from the University of Washington, for her generous help in preparing the manuscript.
References (21)
- et al.
Bone mass and metabolism in patients with celiac disease
Gastroenterology
(1995) - et al.
Body composition and bone mineral density in untreated and treated patients with celiac disease
Bone
(1995) - et al.
Risk of fractures in celiac disease patientsa cross-sectional, case-control study
Am J Gastroenterol
(2000) - et al.
Prevalence of celiac disease in Argentinascreening of an adult population in the La Plata area
Am J Gastroenterol
(2001) - et al.
Osteopenia in patients with clinically silent celiac disease warrants screening
Lancet
(1999) - et al.
Bone density and bone metabolism are normal after long term gluten-free diet in young celiac patients
Am J Gastroenterol
(1999) - et al.
Bone and mineral metabolism in adult celiac disease
Am J Gastroenterol
(1988) - et al.
Bone mineral density in coeliac disease
Scand J Gastroenterol
(1994) - et al.
Bone mineral affection in asymptomatic adult patients with celiac disease
Am J Gastroenterol
(1994) - et al.
Osteoporosis in treated adult coeliac disease
Gut
(1995)
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2015, BoneCitation Excerpt :Other biochemical, densitometric and HR-pQCT parameters were not significantly different according to the concentration level of tTG antibodies. A series of recent studies and a meta-analysis have shown that CD patients have an increased incidence of bone fractures, mostly in the peripheral skeleton [10–16]. Such risk is associated with the symptomatic clinical phenotype at the time of diagnosis, is related to low trauma (osteoporotic fractures), is mainly produced before diagnosis and, finally, may be recurrent in a subset of patients [9–15].
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2020, Journal of Clinical DensitometryCitation Excerpt :Studies on the risk of fracture in adults with CD originally demonstrated conflicting results (72–74). When comparing individuals with a classic presentation of CD to age and sex-matched controls, as well as individuals with subclinical or silent CD, classically symptomatic patients had an increased risk of fractures in the peripheral skeleton (75). In a questionnaire-based case-control study with a mean age of 60.2 ± 10.1 yr among individuals with CD, Thomason et al, demonstrated a numerically but not statistically significant risk of fracture and low-trauma fracture in individuals with CD (73).
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This study was partially funded by the 2002 Research Award “Ramón Carrillo-Arturo Oñativia” from the Ministerio de Salud, Comisión Nacional de Programas de Investigación Sanitaria, Argentina.