Evolution of bone densitometry parameters and risk of fracture in coeliac disease: a 10-year perspective

Abstract

Background Metabolic bone disease is frequently found in patients with coeliac disease (CD). Despite its high prevalence, international guidelines are partially discordant about its management due to the lack of long-term data. Methods We retrospectively evaluated a large dataset of prospectively collected data of CD patients assessing the variation of DXA parameters and estimated fracture risk according to the FRAX® score in a 10-year follow-up. Incident fractures are reported, and the predictive ability of the FRAX® score is verified. Results We identified 107 patients with low bone density (BMD) at the diagnosis of CD and a 10-year follow-up. After improving at the first follow-up, T-scores slowly reduced over time but with no clinically relevant differences between the first and last examination (lumbar spine: from − 2.07 to − 2.07, p = 1.000; femoral neck: from − 1.37 to − 1.55, p = 0.006). Patients with osteoporosis at the index measurement had more marked fluctuations than those with osteopenia; the latter group also showed minimal modifications of the FRAX® score over time. Six incident major fragility fractures occurred, with a good predictive ability of the FRAX® (AUC 0.826). Conclusion Adult CD patients with osteopenia and no risk factors had substantially stable DXA parameters and fracture risk during a 10-year follow-up. A dilated interval between follow-up DXA for these patients could be considered to reduce diagnosis-related time and costs, maintaining a 2-year interval for patients with osteoporosis or risk factors.

Autoimmune Polyendocrine Syndromes in Adult Italian Celiac Disease Patients

“…In a sizeable proportion of cases, however, the diagnosis of CD was suspected based on non-classical manifestations of CD, such as recurrent miscarriages and low bone mass density. Both conditions can be detected by the same specialists that usually follow patients with AED and should trigger investigations for CD, as the prompt start of a GFD can rapidly reduce the risk of further miscarriages, and improve bone mineral density [35,36].…”