Celiac Disease Does Not Influence Fracture Risk in Young Patients with Type 1 Diabetes

Reilly, Norelle R.; Lebwohl, Benjamin; Mollazadegan, Kaziwe; Michaëlsson, Karl; Green, Peter H.R.; Ludvigsson, Jonas F.

doi:10.1016/j.jpeds.2015.10.032

Cited by 7 publications

(9 citation statements)

References 52 publications

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“…(18,44) Even in children with T1D, one study did not find an association between celiac disease and fracture risk. (45) In the present study, we could confirm that children and young adults with T1D and concomitant celiac disease have higher odds for fractures, especially prepubertal, and therefore at least the combination of these two diseases is associated with fracture risk. Unfortunately, we were not able to investigate the vitamin D status, but vitamin D deficiency could be a reason for the higher odds of fractures in individual with celiac disease.…”

Section: Discussionsupporting

confidence: 66%

Bone Fractures in Children and Young Adults With Type 1 Diabetes: Age Distribution, Fracture Location, and the Role of Glycemic Control

Eckert

Semler

Schnabel

et al. 2020

Journal of Bone and Mineral Research

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Type 1 diabetes (T1D) is a known risk factor for fractures, but the underlying pathophysiology is still not fully understood. This study aims to define age peaks and frequent fracture sites of children and young adults with T1D. Additionally, associations of fractures with metabolic and lifestyle factors as well as with additional complications in individuals with T1D were analyzed. A total of 750 individuals with T1D aged ≤25 years with fractures were matched to 3750 patients with T1D without fractures by demographics and insulin regimen. Hemoglobin A1c (HbA1c) values were compared using linear regression, and logistic regression was used to calculate odds ratios (OR) for fractures in individuals with acute complications and diseases. Median (Q1-Q3) age was 12.7 (9.9 to 14.9) years in individuals with fractures and 16.3 (12.6 to 17.8) years in the entire control group with 65% versus 53% males. Peak age for fractures was 7 to <15 years in males and 9 to <11 years in females, which is earlier than reported for the general population. HbA1c (%) was significantly higher in individuals with fractures than in controls (difference of estimated means: 0.26%; 95% confidence interval [CI] 0.07-0.46), especially in postpubertal females (0.68; 0.10-1.26). Significantly higher odds for fractures were observed in individuals with severe hypoglycemia (OR = 1.90; 95% CI 1.47-2.47), especially in prepubertal females (OR = 2.81; 1.21-6.52]) and postpubertal males (2.44; 1.11-5.38), celiac disease (2.02; 1.67-2.45), and with a history of smoking (1.38; 1.02-1.88). The age peak of fractures seems to be earlier in T1D than in the general population. Poor glycemic control is related to fractures, even before puberty. Associations of HbA1c and severe hypoglycemia with fractures highly depend on age and sex.

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Section: Discussionsupporting

confidence: 66%

Bone Fractures in Children and Young Adults With Type 1 Diabetes: Age Distribution, Fracture Location, and the Role of Glycemic Control

Eckert

Semler

Schnabel

et al. 2020

Journal of Bone and Mineral Research

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“…In another study, patients with T1D who developed CD revealed no increase in complication rate in comparison to their counterparts without CD (73, 74). Accordingly, diagnosis of CD in the context of T1D showed no significant impact on HbA1c levels in another study (75).…”

Section: Resultsmentioning

confidence: 89%

“…On the other hand, neither nutritional status, nor life quality of children with concurrent CD and T1D were different compared to individuals with T1D alone ( 72 ). In another study, patients with T1D who developed CD revealed no increase in complication rate in comparison to their counterparts without CD ( 73 , 74 ). Accordingly, diagnosis of CD in the context of T1D showed no significant impact on HbA1c levels in another study ( 75 ).…”

Section: Resultsmentioning

confidence: 89%

An Overview of Celiac Disease in Childhood Type 1 Diabetes

Shahramian

Bazi

Sargazi

2018

Int J Endocrinol Metab

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ContextCeliac disease (CD) is a common phenomenon in children with Type 1 diabetes (T1D). In the present review, we have discussed the pathogenesis, diagnostic biomarkers, risk factors, and prognosis of CD in the context of pediatric T1D.Evidence AcquisitionLiterature published in Web of Science, PubMed, Scopus, Google Scholar, and Cochrane Library were scrutinized up to the end of 2017. The keywords of celiac disease, Type 1 diabetes, children, and pediatric were used in different combinations.ResultsImmune cytotoxic reactions along with dampen immune regulatory functions contribute to CD in the context of pediatric T1D. Many children with simultaneous CD and T1D do not represent with the clinical signs of the enteropathy rendering a diagnostic challenge. The most common screening tests in these children are routine serological tests of CD, anti - endomysial, anti - transglutaminase, and anti - deamidated gliadin peptide antibodies. Typing for human leukocyte antigens of DQ - 2 and DQ - 8 may assist in the diagnosis of silent CD in children with T1D. The most significant shared non - HLA genetic loci of CD and T1D comprise CTLA - 4, TAGAP, IL - 18RAP, PTPN2, RGS1, SH2B3, CCR5. Interactions between these loci can be important in susceptibility to CD in T1D. Some new biomarkers have been suggested for diagnosis of CD including ischemia-modified albumin (IMA), soluble syndecan-1 (SSDC-1), regenerating gene Iα (REG-Iα), Neurotensin, and Zonulin, which can be useful for diagnosis and screening of CD in childhood T1D.ConclusionsOverall, active seropositive CD seems to be of clinical importance in T1D with significant impacts on the quality of life and predisposition to diabetes associated complications. It is important to detect CD in the context of T1D to prevent potential risks contributing to morbidities and mortalities associated with either CD or T1D.

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“…Studies examining fracture outcomes in adults with T1DM + CD are scarce. A prospective cohort study of over 5000 Swedish patients with T1DM did not demonstrate an increased risk of fracture in those with concomitant CD, compared with T1DM alone . However, there were several limitations of the study, including the large patient age range (4 to 71 years old) incomplete reporting of fractures and lack of information on glycaemic control and adherence to a GFD.…”

Section: Discussionmentioning

confidence: 91%

“…As T1DM and CD are both independently associated with bone fragility and fracture risk, this may be additive in T1DM + CD. Few studies have evaluated bone health in those with T1DM + CD, with some studies suggesting a negative impact on bone mineral density (BMD), whereas a large cohort study did not demonstrate increased fracture risk . These studies were primarily conducted in children, and extrapolation of results to an adult population is potentially inappropriate.…”

Section: Introductionmentioning

confidence: 99%

Increased prevalence of fracture and hypoglycaemia in young adults with concomitant type 1 diabetes mellitus and coeliac disease

Thong

Wong

Dev

et al. 2017

Clinical Endocrinology

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Summary Background Both Type 1 diabetes mellitus (T1DM) and coeliac disease (CD) are independently associated with reduced bone mineral density (BMD) and increased fracture risk. Whilst poorer glycaemic control and increased microvascular complications have been described, the literature examining bone health and fractures in adults with concomitant T1DM and CD (T1DM + CD) is limited. Objective To evaluate fracture prevalence and explore associations with glycaemic control, hypoglycaemia and microvascular disease in T1DM + CD compared with T1DM alone. Methods We conducted a retrospective cross‐sectional study of young adults with T1DM, who attended diabetes clinics at a large tertiary referral centre between August 2016 and February 2017. Clinical information, radiological and biochemistry results were extracted from medical records. Patients with comorbid chronic kidney disease, glucocorticoid use, hypogonadism and untreated hyperthyroidism were excluded. Results A total of 346 patients with T1DM alone (median age 23 years) and 49 patients with T1DM + CD (median age 24 years) were included. Median age, gender distribution, BMI, haemoglobin A1c, daily insulin dose and serum 25‐hydroxyvitamin D levels were similar between groups. Higher adjusted fracture risk was observed in T1DM + CD compared with T1DM (12.2% vs 3.5%; OR 3.50, 95% CI 1.01‐12.12, P = .01), yet BMD was only measured in 6% of patients. The adjusted risk of hypoglycaemia ≥2/week was greater for T1DM + CD (55% vs 38%, OR 3.28, 95% CI 1.61‐6.69, P = .001); however, this was not independently associated with fractures. Replete vitamin D (≥ 50 nmol/L) was associated with less hypoglycaemia (OR 0.48, 95% CI 0.29‐0.80; P = .005), but not with fractures. Conclusions Coeliac disease status was independently associated with increased fracture prevalence in young adults with T1DM. Recurrent hypoglycaemia was also increased in T1DM + CD, although hypoglycaemia was not independently associated with fractures. Prospective studies are required to determine the long‐term impacts of CD on bone health and glycaemic control in patients with T1DM.

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Celiac Disease Does Not Influence Fracture Risk in Young Patients with Type 1 Diabetes

Cited by 7 publications

References 52 publications

Bone Fractures in Children and Young Adults With Type 1 Diabetes: Age Distribution, Fracture Location, and the Role of Glycemic Control

Bone Fractures in Children and Young Adults With Type 1 Diabetes: Age Distribution, Fracture Location, and the Role of Glycemic Control

An Overview of Celiac Disease in Childhood Type 1 Diabetes

Increased prevalence of fracture and hypoglycaemia in young adults with concomitant type 1 diabetes mellitus and coeliac disease

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