The Prevalence of Celiac Disease in a Fracture Liaison Service Population

Abstract

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.

Bone Fragility in Gastrointestinal Disorders

“…Likewise, in the Tromsø study cohort, serological markers of celiac disease were more frequent in subjects with incidentally detected secondary hyperPTH when compared with matched control subjects [ 68 ]. Conversely, a more recent retrospective cohort study in patients visiting a Fracture Liaison Service observed an overall prevalence of serologically and bioptically confirmed celiac disease of 0.38%, which falls within the range of prevalence rates described in the Western-European population (0.33–1.5%) [ 69 ].…”

The Dietary and Non-Dietary Management of Osteoporosis in Adult-Onset Celiac Disease: Current Status and Practical Guidance

“…Mucosal villous atrophy in CeD causes decreased calcium absorption, resulting in hypocalcemia and consequently secondary hyperparathyroidism [ 37 ]. The latter stimulates osteoclast-mediated bone resorption; which may lead to osteopenia or osteoporosis.…”