Risk factors associated with osteoporosis in a cohort of prospectively diagnosed adult coeliac patients

Abstract

Background: Up to 75% of patients with untreated coeliac disease (CD) present with osteopenia or osteoporosis. Guidelines do not express with certainty whether each patient with newly diagnosed CD should undergo a dual-energy x-ray absorptiometry (DEXA) scan. Aim: The aim of this article is to evaluate the prevalence of bone mineral density (BMD) alterations at diagnosis and risk factors associated with osteoporosis. Methods: A total of 214 adult patients (median age 38 years; female ¼ 71.5%) newly diagnosed with CD underwent DEXA. The patients were divided into three groups: patients with normal BMD, those with osteopenia and those with osteoporosis. Clinical, histological and serological features were assessed and compared among the three groups. Logistic regression including relevant independent variables was performed. Results: DEXA indicated that 39.7%, 42.5% and 17.8% of the CD patients had normal BMD, osteopenia and osteoporosis, respectively. Logistic regression indicated that features significantly associated with osteoporosis were male gender (OR 4.7; 95%CI 1.1 to 20.8), age !45 years (OR 6.5; 95% CI 1.3 to 32.2), underweight (OR 7.4; 95% CI 1.3 to 42.5) and greater histological damage (Marsh 3C; OR 5.8; 95% CI 1.4 to 24.1). Conclusions: BMD alterations were found in 60.3% of newly diagnosed adult coeliac patients. Osteoporosis was significantly associated with age !45 years, male gender, underweight and Marsh 3C, suggesting that at CD diagnosis, a DEXA scan might be beneficial, particularly in these subgroups of patients. Key summary. Dual-energy x-ray absorptiometry (DEXA) scans have been recommended only for coeliac disease (CD) patients who are peri-or post-menopausal females or males over 55 years and those with overt malabsorption or a history of fragility fractures. . In this study, bone mineral density alterations were found in 60.3% of newly diagnosed adult CD patients.. Osteoporosis was significantly associated with age !45 years, male gender, underweight and Marsh 3C, suggesting that at CD diagnosis, a DEXA scan might be beneficial.

Non-classical clinical presentation at diagnosis by male celiac disease patients of older age

“…Recognizing and treating CeD that manifests late in life is important because it can reduce the chance of complications such as osteoporosis, and its concomitant risk of fractures, even with the high treatment burden a GFD [18]. For example, in a previous cohort, male sex and older age were significant independent risk factors for osteoporosis in CeD (anemia: OR=2.5, adjusted P = 0.002; Male: OR=2.2, P = 0.2; increasing age at diagnosis (years): OR 1.04, P<0.001) [19].…”

Do Alterations in Bone Mineral Density Go Beyond Borders in Adults With Celiac Disease?

“…We are grateful to Dr Galli and colleagues 1 for their interest in our work demonstrating the value of bone mineral density (BMD) measurement by dual x-ray absorptiometry (DXA) in adults with celiac disease (CD). 2 Our study findings highlight the importance of BMD assessment in CD, not only at the lumbar spine and hip skeletal sites but also at the distal 1/3 radius, particularly in men and Clinical Gastroenterology and Hepatology 2020;18:750-759…”

Review article: Follow‐up of coeliac disease

“…Guidelines differ in whom and when to perform bone mineral densitometry. Testing should always be considered in patients at higher risk for bone density loss, for example long delay to diagnosis, malabsorption, severe villous atrophy at diagnosis, perimenopause or menopause in women, age >45 to 50 years in men and a history of fragility fracture 101,104 . Otherwise, it is reasonable to consider testing within a year of diagnosis and not later than 30–35 years of age 5,104 .…”