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

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Author(s): 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

Journal: World Journal of Gastroenterology
ISSN 1007-9327

Volume: 17;
Issue: 25;
Start page: 3035;
Date: 2011;
Original page

Keywords: Celiac disease | Fracture risk | Peripheral fractures | Gluten-free diet | Sex difference

ABSTRACT
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.

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