Fracture risk assessment in celiac disease: a registry-based cohort study
Fracture risk assessment in celiac disease: a registry-based cohort study
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.
Celiac disease, Epidemiology, FRAX score, Major osteoporotic fracture risk, Osteoporosis
93-99
Duerksen, D.R.
bc01f92c-d809-47e1-8666-7c18f344dae7
Lix, L.M.
2fb61783-047d-4a4b-a45d-e09ac0763a7b
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, J.A,
52c2c5a7-a17a-49dd-9b2a-30b5a1750a5d
Leslie, W.D.
0c9bc973-969a-4049-aeb0-44a536074fb1
January 2021
Duerksen, D.R.
bc01f92c-d809-47e1-8666-7c18f344dae7
Lix, L.M.
2fb61783-047d-4a4b-a45d-e09ac0763a7b
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, J.A,
52c2c5a7-a17a-49dd-9b2a-30b5a1750a5d
Leslie, W.D.
0c9bc973-969a-4049-aeb0-44a536074fb1
Duerksen, D.R., Lix, L.M., Johansson, H., McCloskey, E.V., Harvey, N.C., Kanis, J.A, and Leslie, W.D.
(2021)
Fracture risk assessment in celiac disease: a registry-based cohort study.
Osteoporosis International, 32 (1), .
(doi:10.1007/s00198-020-05579-7).
Abstract
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.
Text
Frax and Celiac Manuscript 21July20-accepted
- Accepted Manuscript
More information
Accepted/In Press date: 29 July 2020
e-pub ahead of print date: 3 August 2020
Published date: January 2021
Additional Information:
Funding Information:
This study received no external funding. LML is supported by a Tier I Canada Research Chair.
Funding Information:
Eugene McCloskey: Nothing to declare for the context of this paper, but numerous ad hoc consultancies/speaking honoraria and/or research funding from Amgen, Bayer, General Electric, GSK, Hologic, Lilly, Merck Research Labs, Novartis, Novo Nordisk, Nycomed, Ono, Pfizer, ProStrakan, Roche, Sanofi-Aventis, Servier, Tethys, UBS, and Warner-Chilcott.
Publisher Copyright:
© 2020, International Osteoporosis Foundation and National Osteoporosis Foundation.
Keywords:
Celiac disease, Epidemiology, FRAX score, Major osteoporotic fracture risk, Osteoporosis
Identifiers
Local EPrints ID: 443406
URI: http://eprints.soton.ac.uk/id/eprint/443406
ISSN: 0937-941X
PURE UUID: c2403aa9-656f-4722-b4f3-0a891c8a87c1
Catalogue record
Date deposited: 24 Aug 2020 16:34
Last modified: 17 Mar 2024 05:49
Export record
Altmetrics
Contributors
Author:
D.R. Duerksen
Author:
L.M. Lix
Author:
H. Johansson
Author:
E.V. McCloskey
Author:
J.A, Kanis
Author:
W.D. Leslie
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
