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

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
0937-941X
93-99
Duerksen, D.R.
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Lix, L.M.
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Johansson, H.
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McCloskey, E.V.
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Harvey, N.C.
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Kanis, J.A,
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Leslie, W.D.
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Duerksen, D.R.
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Lix, L.M.
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Johansson, H.
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McCloskey, E.V.
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Harvey, N.C.
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Kanis, J.A,
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Leslie, W.D.
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Duerksen, D.R., Lix, L.M., Johansson, H., McCloskey, E.V., Harvey, N.C., Kanis, J.A, and Leslie, W.D. (2020) Fracture risk assessment in celiac disease: a registry-based cohort study. Osteoporosis International, 32 (1), 93-99.

Record type: Article

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.

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Frax and Celiac Manuscript 21July20-accepted - Accepted Manuscript
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Accepted/In Press date: 29 July 2020
e-pub ahead of print date: 3 August 2020
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
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 24 Aug 2020 16:34
Last modified: 26 Nov 2021 05:19

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Contributors

Author: D.R. Duerksen
Author: L.M. Lix
Author: H. Johansson
Author: E.V. McCloskey
Author: N.C. Harvey ORCID iD
Author: J.A, Kanis
Author: W.D. Leslie

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