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Fracture risk assessment in celiac disease: a registry-based cohort study
D R Duerksen1, L M Lix2, H Johansson3,4
1University of Manitoba, Winnipeg, Canada. dduerkse@sbgh.mb.ca.
Insights
Celiac disease increases major osteoporotic fracture risk. However, the FRAX® tool accurately predicts this risk when celiac disease is considered a secondary osteoporosis factor or bone mineral density is included.
Area of Science:
- Osteoporosis Research
- Celiac Disease Studies
- Fracture Risk Assessment
Background:
- The Fracture Risk Assessment Tool (FRAX®) predicts 10-year major osteoporotic (MOF) fracture probability using clinical factors and bone mineral density (BMD).
- Celiac disease is linked to higher fracture risk but isn't a direct input in standard FRAX® calculations.
Purpose of the Study:
- To evaluate if celiac disease independently elevates MOF risk beyond the FRAX® score.
- To determine if FRAX® accurately predicts fracture risk in celiac disease patients when adjusted for secondary osteoporosis or BMD.
Main Methods:
- Utilized the Manitoba BMD Registry, linking clinical data, BMD, FRAX® scores, and celiac disease diagnoses.
- Tracked incident MOF diagnoses over 10 years in celiac disease and general population cohorts using healthcare databases.
Main Results:
- Celiac disease correlated with a 43% increased fracture risk when FRAX® did not account for secondary osteoporosis or BMD.
- This association disappeared when celiac disease was treated as a secondary osteoporosis risk factor or BMD was included in FRAX®.
- FRAX® accurately estimated 10-year MOF probability in celiac disease patients when adjusted.
Conclusions:
- Celiac disease is an independent risk factor for major osteoporotic fractures.
- FRAX® accurately predicts fracture risk in individuals with celiac disease when it's considered a secondary osteoporosis risk factor or BMD is incorporated.
Abstract:
Celiac disease is associated with an increased fracture risk but is not a direct input to the FRAX® calculation. When celiac disease is considered as a secondary osteoporosis risk factor or BMD is included in the FRAX assessment, FRAX accurately predicts fracture risk.
Introduction:
The fracture risk assessment tool (FRAX®) uses clinical factors and bone mineral density (BMD) measurement to predict 10-year major osteoporotic (MOF) fracture probability. The study aim was to determine whether celiac disease affects MOF risk independent of FRAX score.
Methods:
The Manitoba BMD Registry includes clinical data, BMD measurements, 10-year probability of MOF calculated for each individual using the Canadian FRAX tool and diagnosed celiac disease. Using linkage to population-based healthcare databases, we identified incident MOF diagnoses over the next 10 years for celiac disease and general population cohorts.
Results:
Celiac disease (N = 693) was associated with increased fracture risk adjusted for FRAX score computed without secondary osteoporosis or BMD (adjusted hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.11-1.86). Celiac disease was no longer a significant risk factor for fracture when secondary osteoporosis or BMD were included in the FRAX calculation (p > 0.1). In subjects with celiac disease, each SD increase in FRAX score (calculated with and without secondary osteoporosis or BMD) was associated with higher risk of incident MOF (adjusted HR 1.66 to 1.80), similar to the general population (p-interaction > 0.2). Including celiac disease as secondary osteoporosis or including BMD in FRAX 10-year MOF probability calculations (10.1% and 8.6% respectively) approximated the observed cumulative 10-year MOF probability (10.8%, 95% CI 7.8-13.9%).
Conclusions:
Celiac disease is associated with an increased risk of major osteoporotic fractures. When celiac disease is considered as a secondary osteoporosis risk factor or BMD is included in FRAX assessment, FRAX accurately predicts fracture risk.
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