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©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
Risk of fracture in celiac disease: Gender, dietary compliance, or both?
María Inés Pinto Sánchez, Adriana Mohaidle, Andrea Baistrocchi, Dolores Matoso, Horacio Vázquez, Andrea González, Roberto Mazure, Evangelina Maffei, Guillermina Ferrari, Edgardo Smecuol, Adriana Crivelli, Juan Andrés de Paula, Juan C Gómez, Silvia Pedreira, Eduardo Mauriño, Julio César Bai
María Inés Pinto Sánchez, Horacio Vázquez, Andrea González, Roberto Mazure, Edgardo Smecuol, Eduardo Mauriño, Julio César Bai, Small Bowel Section, Department of Medicine, “Dr. C. Bonorino Udaondo” Gastroenterology Hospital, 1264 Buenos Aires, Argentina
Adriana Mohaidle, Silvia Pedreira, Department of Gastroenterology, German Hospital, 1118 Buenos Aires, Argentina
Andrea Baistrocchi, Evangelina Maffei, Guillermina Ferrari, Adriana Crivelli, Juan C Gómez, Nutritional Support Unit and Malabsortion, “San Martin” HIGA, 1900 La Plata, Argentina
Dolores Matoso, Juan Andrés de Paula, Department of Gastroenterology, Italian Hospital, 1181 Buenos Aires, Argentina
Author contributions: Pinto Sánchez MI, Mohaidle A, Baistrocchi A, Matoso D, Maffei E, Ferrari G, Crivelli A, Smecuol E and Mazure R collected the data; Pinto Sánchez MI and Vázquez H provided the statistical analysis; González A, de Paula JA, Pedreira S, Gómez JC and Mauriño E were involved in study design, supervision of database and critical revision of the manuscript; Bai JC designed and supervised the study and wrote the manuscript
Supported by (partially) Asociacion para el Estudio de las Enfermedades del Intestino; Vázquez H, Smecuol E and Bai JC are members of the Consejo de Investigacion en Salud, Gobierno de la Ciudad de Buenos AIres
Correspondence to: Julio C Bai, MD, Professor, Small Bowel Section, Department of Medicine, “Dr. C. Bonorino Udaondo” Gastroenterology Hospital, 1264 Buenos Aires, Argentina. jbai@intramed.net
Telephone: +54-11-43064641-117 Fax: +54-11-43041018
Received: December 16, 2010
Revised: January 2, 2011
Accepted: January 9, 2011
Published online: July 7, 2011
AIM: To determine the incidence of peripheral fractures in patients with celiac disease (CD) and the effect of treatment on fracture risk.
METHODS: We compared the incidence and risk of peripheral fractures before and after diagnosis between a cohort of 265 patients who had been diagnosed with CD at least 5 years before study entry and a cohort of 530 age- and sex-matched controls who had been diagnosed with functional gastrointestinal disorders. Data were collected through in-person interviews with an investigator. The overall assessment window for patients was 9843 patient-years (2815 patient-years after diagnosis).
RESULTS: Compared with the control group, the CD cohort showed significantly higher incidence rate and risk of first peripheral fracture before diagnosis [adjusted hazard ratio (HR): 1.78, 95% CI: 1.23-2.56, P < 0.002] and in men (HR: 2.67, 95% CI: 1.37-5.22, P < 0.004). Fracture risk was significantly associated with the classic CD presentation with gastrointestinal symptoms (P < 0.003). In the time period after diagnosis, the risk of fractures was comparable between the CD cohort and controls in both sexes (HR: 1.08, 95% CI: 0.55-2.10 for women; HR: 1.57, 95% CI: 0.57-4.26 for men).
CONCLUSION: CD patients have higher prevalence of fractures in the peripheral skeleton before diagnosis. This is associated with male sex and classic clinical presentation. The fracture risk was reduced after the treatment.
