Introduction Patients with coeliac disease (CD) should be seen annually for a clinical review, blood tests and have a DEXA scan if needed 1,2. The indication for a DEXA scan is unclear due to conflicting recommendations in current guidelines2,3. The aim of our study was to audit our practice, with a focus on requests for DEXA scans.
Method This was a single centre, retrospective study of CD patients under the care of 3 consultants. We accessed the electronic records to identify if haematological and biochemical profiles were being monitored annually. We also identified when patients had their first DEXA scans and whether or not they were indicated2,3.
Results Data were collected on 160 patients (F=107 [67%]). Annual checks of FBC occurred in 94% of patients, vitamin B12 in 74%, folate in 77%, ferritin in 88%, calcium in 85% and vitamin D in 69%. DEXA scans occurred in 74% of patients (n=119), including 65% (n=77) who were screened around the time of diagnosis. However, only 24% (n=28) actually warranted the scan according to guidelines2,3, and 68% (n=81) did not fulfil criteria for a DEXA. In 8% of patients (n=10), there was inadequate data. Of the 81 patients who did not warrant a DEXA scan, 77 results were available: normal in 48% (n=37), osteopenia in 43% (n=33) and osteoporosis in 9% (n=7). Of the 7 patients that had osteoporosis, 4 patients were under 50 years old (57%). Of the appropriate DEXA requests, 25% (n=7) were normal, 39% (n=11) had osteopenia and 36% (n=10) had osteoporosis.
Conclusion Most CD patients require very little clinical input at their routine appointments. Annual blood checks and adherence to a gluten free diet are standard enquiries. However, there is a cohort of patients who are not getting their regular blood tests: 33% for bone profile and 25% for haematinics. Clinicians tend to order a DEXA in most CD patients because it is easier than attempting to judge an individual’s risk in the setting of conflicting guidance2,3. The pick-up rate of osteoporosis in 36% of appropriately screened patients (vs 9% in inappropriate scan requests) suggests that targeted screening allows for a more rational and cost-effective use of a limited resource. We hope that the guidelines can now be updated with more clarity for the practitioners who request DEXA scans in CD patients.
. Coeliac disease: recognition, assessment and management. NICE guideline [NG20]. Sept 2015
. Ludvigsson JF, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut2014;63:1210–28.
. Osteoporosis: assessing the risk of fragility fracture. NICE Guideline (CG146). Aug 2012.
Disclosure of Interest None Declared