Risk of fractures in dermatitis herpetiformis and coeliac disease: a register-based study

Abstract

Objectives: Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. Bone fracture risk is increased in coeliac disease, but little knowledge exists about bone complications in DH. This study aimed to evaluate the risk of hip and other hospital-treated fractures in DH and coeliac disease in a high prevalence area with good adherence to a gluten-free diet.Materials and methods: Hip, proximal humerus, wrist and ankle fractures in 368 treated DH and 1,076 coeliac disease patients between 1970 and 2015 were reviewed from the National Hospital Discharge Register. Hip fracture incidence rates for DH and coeliac disease patients were compared to those for the general population. The overall fracture risk for DH was compared to coeliac disease. Results:The hip fracture incidence rates for DH and coeliac disease patients did not differ from the general population. In females aged 80-89, the hip fracture incidence was higher in DH than in coeliac disease, but the risk for any hospital-treated fracture was lower in DH compared to coeliac disease (adjusted HR 0.620, 95% CI 0.429-0.949). The DH and coeliac disease patients with hospital-treated fractures were diagnosed at an older age, but the degree of small bowel mucosal damage did not significantly differ between patients with and without fractures. Conclusion:The incidence of hip fracture is not increased in treated DH or coeliac disease in an area with high awareness and dietary compliance rates. However, patients with DH seem to have lower risk for fractures overall compared to coeliac disease.

Dual X-ray absorptiometry-derived bone status indexes and videocapsule intestinal aspects in celiac disease

“…Otherwise, Pasternack et al . [26] did not find an increased risk of hip fracture in treated CeD or dermatitis herpetiformis, with the latter disease showing a smaller risk than CeD. Other studies claimed increased bone fragility of the distal radius in CeD and recommended DXA screening in all CeD patients, particularly those with symptomatic CeD at diagnosis and those with other risk factors for fracture such as older age, menopausal status, previous fracture history and familial hip fracture history.…”

Review article: Systemic consequences of coeliac disease

“…17,[34][35][36] In fact, the early coeliac disease diagnosis might be especially important in paediatric patients, as the peak bone mass is achieved during young adulthood, 37 and thus the bone accrual may remain incomplete if the diagnosis is delayed. Whether the dietary treatment also decreases the fracture risk remains more controversial, as in some studies their frequency has decreased to the level of general population, 27,38,39 whereas in others the risk has remained elevated. 25,26 In a Swedish register-based study, F I G U R E 1 Wide range of possible clinical consequences of coeliac disease outside gastrointestinal tract ongoing fracture risk was associated with slow histological recovery, suggesting that this may be attributable to either a more severe duodenal lesion at diagnosis or poor dietary adherence-or both.…”

Risk of vascular diseases in patients with dermatitis herpetiformis and coeliac disease: a long-term cohort study

“…Adherence to GFD has additionally important prognostic significance as it has been shown to protect against lymphoma and bone fractures, possible complications of both coeliac disease and DH [ 4 , 5 ]. However, there is evidence suggesting that the long-term prognosis of patients with DH and coeliac disease differs in some respects, since patients with DH have shown to be at lower risk for bone complications and renal comorbidities than patients with other phenotypes of coeliac disease [ 6 , 7 ]. Mortality among coeliac disease patients has moreover been shown in several studies to be increased [ 8 ], while in DH there are few studies indicating lower mortality rates than in general population [ 9–11 ].…”