Introduction Coeliac disease may be associated with osteoporosis and increased fracture risk. Osteoporosis is a significant public health problem with major consequences for patients and health care systems.1 Debate exists concerning the utility of routine bone mineral density (BMD) assessment in patients with coeliac disease.2 We aimed to identify the prevalence of osteoporosis in patients with coeliac disease as defined by BMD assessment.
Methods Dietitian led data sets are currently maintained for all coeliac patients under active follow-up at University Hospital Aintree. We retrospectively analysed this information to determine (1) the frequency of BMD assessment in coeliac patients and, (2) the results of BMD assessment. Osteoporosis was defined as a T score of ≤−2.5 SDs below mean at either lumbar spine or hip.
Results The data sets for 232 patients were available for analysis. Demographics: 70% female, 30% male, mean age at diagnosis 52 (range 3–79 years). BMD assessment was undertaken in 211 (91%). The indication for this assessment in all cases was a clinicopathological diagnosis of coeliac disease. Of those undergoing BMD assessment, 26% had osteoporosis. On questioning at outpatient assessment 141 (67%) patients reported participation in regular weight bearing exercise. Of these patients 33 (24%) had osteoporosis compared to 10/30 (33%) not documented to undertake weight bearing exercise (p=0.26). Of those undergoing BMD assessment, 128 (61%) had been prescribed calcium supplements. 49/128 (38%) patients documented to be taking calcium supplements had BMD measurements consistent with osteoporosis compared to 4/82 (5%) patients not taking calcium supplements.
Conclusion At this UK centre, where over 90% of patients with coeliac disease underwent BMD assessment, 26% had osteoporosis. This is comparable to the rate demonstrated by Fitzgerald et al (25%)3 and provides further support for the routine use of BMD assessment in coeliac disease to screen for osteoporosis. A lesser proportion of patients who participated in regular weight bearing exercise had osteoporosis at BMD assessment, but this finding was not statistically significant.
Competing interests None declared.
References 1. Lewis NR, Scott BB. Guidelines for Osteoporosis in Inflammatory Bowel Disease and Coeliac Disease. BSG Guidelines in Gastroenterology, 2007. http://www.bsg.org.uk/clinical-guidelines/ibd/guidelines-for-osteoporosis-in-inflammatory-bowel-disease-and-coeliac-disease.html
2. Lewis NR, Scott BB. Should patients with coeliac disease have their bone mineral density measured? Eur J Gastroenterol Hepatol 2005;17:1065–70.
3. Fitzgerald T, Davies H, Howdle PD, et al. Prevalence of osteoporosis in Leeds coeliac cohort. Gut 2011;60:A91.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.