Risk of fracture in celiac disease: Gender, dietary compliance, or both?

Table 1 Demography, clinical information and data on fractures in the peripheral skeleton of celiac disease patients and disease controls (Functional gastrointestinal disorders) at the time of the study

	CD patients	Control population	P value
No. of patients (F/M)	265 (223/42)	530 (446/84)
Median age (yr) (range)	42 (18-85)	43 (16-87)
Age at diagnosis (yr) median (range)	30 (1-80)	-
BMI (kg/m2, mean ± SE)	22.5 ± 0.2	24.3 ± 0.2	0.001
Age at menarche (yr) median (range)	13 (9-17)	12 (9-20)
Age at menopause (yr) median (range)	48 (30-54)	49 (36-59)
Person-years before diagnosis	7028	14 532
Person-years after diagnosis	2815	5628
Total No. of fractures	89	93	0.0001
Total No. of cases with at least one fracture	61	82	0.02
No. of patients with at least one fracture before diagnosis	40	45	0.006
No. of patients with at least one fracture after diagnosis	21	37
Age at first fracture before diagnosis (yr), median (range)	10 (2-61)	15 (1-74)
Age at first fracture after diagnosis (yr), median (range)	21 (5-75)	37 (6-71)
Type of trauma producing fracture (No. of cases)
Mild	27	24
Moderate	24	34
Severe/sports	10	24

CD: Celiac disease; BMI: Body mass index.

Table 2 Clinical characteristics and fracture history of celiac disease patients according to gender

	Female	Male	P value
No. of patients	223	42
Median age (yr), range	42 (18-62)	35 (18-66)	0.04
Age at diagnosis (yr), median (range)	31 (1-80)	19 (1-52)	0.003
BMI (kg/m2, mean ± SD)	22.5 ± 0.5	23.7 ± 0.6	0.01
Person-years before diagnosis	6380	647
Person-years after diagnosis	2371	444
Total no. of fractures	57	32	0.0001
Total no. of cases with at least one fracture	42	19	0.0005
No. of patients with at least one fracture before diagnosis	29	11	0.05
No. of patients with at least one fracture after diagnosis	13	8	0.01
Age at first fracture before diagnosis (yr), median (range)	14 (2-61)	10 (6-32)	0.04
Age at first fracture after diagnosis (yr), median (range)	54 (5-75)	13 (5-60)
Type of trauma producing first fracture (No. of cases)
Mild	20	7
Moderate	18	6
Severe/sportive	4	6

Table 3 Crude risk of fracture, adjusted risk of fractures and incidence rates (events/1000 subjects per year) in the peripheral skeleton in celiac disease patients compared to control population according to gender

	CD patients	Controls	HR (95% CI)	P
Before diagnosis
Overall population
IR	8.67	5.64	1.53 (1.05-2.14)	0.01
Adjusted HR			1.78 (1.23-2.56)	0.002
Females
IR	6.58	5.09	1.28 (0.87-1.88)	NS
Adjusted HR			1.52 (0.99-2.32)	0.052
Males
IR	29.35	10.20	2.67 (1.37-5.22)	0.004
Adjusted HR			2.63 (1.24-5.59)	0.01
After diagnosis
Overall population
IR	7.45	6.04	1.28 (0.74-2.21)	NS
Adjusted HR			No significant change
Females
IR	5.48	5.30	1.08 (0.55-2.10)	NS
Adjusted HR			No significant change
Males
IR	18.02	9.83	1.57 (0.57-4.26)	NS
Adjusted HR			No significant change

Hazard ratios (HRs) were adjusted by age at enrollment, age at diagnosis, body mass index (BMI), smoking habits and menopause. CD: Celiac disease; IR: Incidence rate.