Positive IgA against transglutaminase 2 in patients with distal radius and ankle fractures compared to community-based controls

Hjelle, Anja Myhre; Apalset, Ellen M; Mielnik, Paweł; Nilsen, Roy Miodini; Lundin, Knut E.A.; Tell, Grethe S.

doi:10.1080/00365521.2018.1509122

Cited by 6 publications

(6 citation statements)

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“…In the control group of 197 patients, four had biopsy-proven CD (2.0%) and in one patient with positive serology no biopsy was performed. Serology was only positive in two controls because of the use of a gluten-free diet in three known CD patients [40]. In this study, in patients with a fracture a positive anti-tTg IgA was more prevalent than in controls, but the prevalence of biopsy-proven CD in the fracture cohort was comparable to the control cohort.…”

Section: Discussioncontrasting

confidence: 46%

“…This might be important, given the fact that CD is associated with increased fracture risk [6,13]. Hjelle et al studied the prevalence of CD in 400 patients aged 40 years or older with a distal radius or ankle fracture compared to community-based controls [40]. The diagnosis of CD was based on serological screening of anti-tTg IgA in combination with histology from duodenal biopsy or a previous diagnosis of CD.…”

Section: Discussionmentioning

confidence: 99%

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The Prevalence of Celiac Disease in a Fracture Liaison Service Population

et al. 2020

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Celiac disease (CD) is a known risk factor for osteoporosis and fractures. The prevalence of CD in patients with a recent fracture is unknown. We therefore systematically screened patients at a fracture liaison service (FLS) to study the prevalence of CD. Patients with a recent fracture aged ≥ 50 years were invited to VieCuri Medical Center’s FLS. In FLS attendees, bone mineral density (BMD) and laboratory evaluation for metabolic bone disorders and serological screening for CD was systematically evaluated. If serologic testing for CD was positive, duodenal biopsies were performed to confirm the diagnosis CD. Data were collected in 1042 consecutive FLS attendees. Median age was 66 years (Interquartile range (IQR) 15), 27.6% had a major and 6.9% a hip fracture, 26.4% had osteoporosis and 50.8% osteopenia. Prevalent vertebral fractures were found in 29.1%. CD was already diagnosed in two patients (0.19%), one still had a positive serology. Three other patients (0.29%) had a positive serology for CD (one with gastro-intestinal complaints). In two of them, CD was confirmed by duodenal histology (0.19%) and one refused further evaluation. The prevalence of biopsy-proven CD was therefore 0.38% (4/1042) of which 0.19% (2/1042) was newly diagnosed. The prevalence of CD in patients with a recent fracture at the FLS was 0.38% and within the range of reported prevalences in the Western-European population (0.33–1.5%). Newly diagnosed CD was only found in 0.19%. Therefore, standard screening for CD in FLS patients is not recommended.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

The Prevalence of Celiac Disease in a Fracture Liaison Service Population

et al. 2020

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“…The study was primarily designed to explore the prevalence of celiac disease in patients with peripheral fractures compared to community-based controls. The original study has previously been described [13]. Fracture patients who fulfilled the inclusion criteria and consented to participate were referred for DXA scan and consideration of secondary fracture prevention (n = 516).…”

Section: Subjectsmentioning

confidence: 99%

“…BMI was calculated and categorized into underweight (BMI < 18.5), normal weight (BMI 18.5-24.99), overweight (BMI 25-29.99) and obesity (BMI ≥ 30). Blood tests were analyzed to detect common causes of secondary osteoporosis [13].…”

Section: Procedures and Measurementsmentioning

confidence: 99%

No association between osteoporosis and AO classification of distal radius fractures: an observational study of 289 patients

Hjelle

Gjertsen

Apalset

et al. 2020

BMC Musculoskelet Disord

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Background It is mechanically plausible that osteoporosis leads to more severe peripheral fractures, but studies investigating associations between BMD and radiographically verified complexity of distal radius fractures are scarce. This study aims to study the association between osteoporosis, as well as other risk factors for fracture, and the AO classification of distal radius fractures. Methods In this observational study, 289 consecutive patients aged ≥40 years with a distal radius fracture were included. Bone mineral density (BMD) of the hips and spine was measured by dual-energy x-ray absorptiometry (DXA), and comorbidities, medication, physical activity, smoking habits, body mass index (BMI), and history of previous fracture were registered. The distal radius fractures were classified according to the Müller AO system (AO) (type B and C regarded as most complex). Results Patients with osteoporosis (n = 130) did not have increased odds of a more complex distal radius fracture (type B + C, n = 192)) (n = vs type A (n = 92) (OR 1.1 [95% CI 0.5 to 2.3]) compared to those with osteopenia /normal BMD (n = 159). Patients with AO fracture types A or C had a higher prevalence of osteoporosis than patients with type B fracture. Conclusions Distal radius fracture patients with osteoporosis did not sustain more complex fractures than those with osteopenia/normal BMD according to the AO classification system. The AO classification of distal radius fracture cannot be used to decide which patients should be referred to DXA scan and considered for secondary fracture prevention.

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“…Agardh et al 358 Choung et al 360 Heikkilä et al 321 Hjelle et al 355 Hjelle et al 354 LeBoff et al 356 Potter et al 357 West et al 359 315 El-Matary et al 366 Horoldt et al 363 Kull et al 367 Leeds et al 364 Watanabe et al 365 277 Oana et al 387 Bizzaro et al 315 Chatzicostas et al 381 Durante-Mangoni et al 382 El-Shabrawi et al 386 Germenis et al 388 Hernandez et al 383 Hujoel et al 290 Sjöberg et al 384 Villalta et al 389 Villalta et al 389 Vivas et al 301 Yap et al 276 Yuan et al 385 Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaption in any medium and for any purpose provided that it is properly attributed.…”

Section: Referencementioning

confidence: 99%

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling

Elwenspoek

Thom

Sheppard

et al. 2022

Health Technol Assess

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Background Coeliac disease is an autoimmune disorder triggered by ingesting gluten. It affects approximately 1% of the UK population, but only one in three people is thought to have a diagnosis. Untreated coeliac disease may lead to malnutrition, anaemia, osteoporosis and lymphoma. Objectives The objectives were to define at-risk groups and determine the cost-effectiveness of active case-finding strategies in primary care. Design (1) Systematic review of the accuracy of potential diagnostic indicators for coeliac disease. (2) Routine data analysis to develop prediction models for identification of people who may benefit from testing for coeliac disease. (3) Systematic review of the accuracy of diagnostic tests for coeliac disease. (4) Systematic review of the accuracy of genetic tests for coeliac disease (literature search conducted in April 2021). (5) Online survey to identify diagnostic thresholds for testing, starting treatment and referral for biopsy. (6) Economic modelling to identify the cost-effectiveness of different active case-finding strategies, informed by the findings from previous objectives. Data sources For the first systematic review, the following databases were searched from 1997 to April 2021: MEDLINE® (National Library of Medicine, Bethesda, MD, USA), Embase® (Elsevier, Amsterdam, the Netherlands), Cochrane Library, Web of Science™ (Clarivate™, Philadelphia, PA, USA), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and the National Institutes of Health Clinical Trials database. For the second systematic review, the following databases were searched from January 1990 to August 2020: MEDLINE, Embase, Cochrane Library, Web of Science, Kleijnen Systematic Reviews (KSR) Evidence, WHO ICTRP and the National Institutes of Health Clinical Trials database. For prediction model development, Clinical Practice Research Datalink GOLD, Clinical Practice Research Datalink Aurum and a subcohort of the Avon Longitudinal Study of Parents and Children were used; for estimates for the economic models, Clinical Practice Research Datalink Aurum was used. Review methods For review 1, cohort and case–control studies reporting on a diagnostic indicator in a population with and a population without coeliac disease were eligible. For review 2, diagnostic cohort studies including patients presenting with coeliac disease symptoms who were tested with serological tests for coeliac disease and underwent a duodenal biopsy as reference standard were eligible. In both reviews, risk of bias was assessed using the quality assessment of diagnostic accuracy studies 2 tool. Bivariate random-effects meta-analyses were fitted, in which binomial likelihoods for the numbers of true positives and true negatives were assumed. Results People with dermatitis herpetiformis, a family history of coeliac disease, migraine, anaemia, type 1 diabetes, osteoporosis or chronic liver disease are 1.5–2 times more likely than the general population to have coeliac disease; individual gastrointestinal symptoms were not useful for identifying coeliac disease. For children, women and men, prediction models included 24, 24 and 21 indicators of coeliac disease, respectively. The models showed good discrimination between patients with and patients without coeliac disease, but performed less well when externally validated. Serological tests were found to have good diagnostic accuracy for coeliac disease. Immunoglobulin A tissue transglutaminase had the highest sensitivity and endomysial antibody the highest specificity. There was little improvement when tests were used in combination. Survey respondents (n = 472) wanted to be 66% certain of the diagnosis from a blood test before starting a gluten-free diet if symptomatic, and 90% certain if asymptomatic. Cost-effectiveness analyses found that, among adults, and using serological testing alone, immunoglobulin A tissue transglutaminase was most cost-effective at a 1% pre-test probability (equivalent to population screening). Strategies using immunoglobulin A endomysial antibody plus human leucocyte antigen or human leucocyte antigen plus immunoglobulin A tissue transglutaminase with any pre-test probability had similar cost-effectiveness results, which were also similar to the cost-effectiveness results of immunoglobulin A tissue transglutaminase at a 1% pre-test probability. The most practical alternative for implementation within the NHS is likely to be a combination of human leucocyte antigen and immunoglobulin A tissue transglutaminase testing among those with a pre-test probability above 1.5%. Among children, the most cost-effective strategy was a 10% pre-test probability with human leucocyte antigen plus immunoglobulin A tissue transglutaminase, but there was uncertainty around the most cost-effective pre-test probability. There was substantial uncertainty in economic model results, which means that there would be great value in conducting further research. Limitations The interpretation of meta-analyses was limited by the substantial heterogeneity between the included studies, and most included studies were judged to be at high risk of bias. The main limitations of the prediction models were that we were restricted to diagnostic indicators that were recorded by general practitioners and that, because coeliac disease is underdiagnosed, it is also under-reported in health-care data. The cost-effectiveness model is a simplification of coeliac disease and modelled an average cohort rather than individuals. Evidence was weak on the probability of routine coeliac disease diagnosis, the accuracy of serological and genetic tests and the utility of a gluten-free diet. Conclusions Population screening with immunoglobulin A tissue transglutaminase (1% pre-test probability) and of immunoglobulin A endomysial antibody followed by human leucocyte antigen testing or human leucocyte antigen testing followed by immunoglobulin A tissue transglutaminase with any pre-test probability appear to have similar cost-effectiveness results. As decisions to implement population screening cannot be made based on our economic analysis alone, and given the practical challenges of identifying patients with higher pre-test probabilities, we recommend that human leucocyte antigen combined with immunoglobulin A tissue transglutaminase testing should be considered for adults with at least a 1.5% pre-test probability of coeliac disease, equivalent to having at least one predictor. A more targeted strategy of 10% pre-test probability is recommended for children (e.g. children with anaemia). Future work Future work should consider whether or not population-based screening for coeliac disease could meet the UK National Screening Committee criteria and whether or not it necessitates a long-term randomised controlled trial of screening strategies. Large prospective cohort studies in which all participants receive accurate tests for coeliac disease are needed. Study registration This study is registered as PROSPERO CRD42019115506 and CRD42020170766. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 44. See the NIHR Journals Library website for further project information.

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Positive IgA against transglutaminase 2 in patients with distal radius and ankle fractures compared to community-based controls

Cited by 6 publications

References 50 publications

The Prevalence of Celiac Disease in a Fracture Liaison Service Population

The Prevalence of Celiac Disease in a Fracture Liaison Service Population

No association between osteoporosis and AO classification of distal radius fractures: an observational study of 289 patients

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling

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