Gastroenterology

Gastroenterology

Volume 125, Issue 2, August 2003, Pages 429-436
Gastroenterology

Clinical-alimentary tract
Fracture risk in people with celiac disease: a population-based cohort study

https://doi.org/10.1016/S0016-5085(03)00891-6Get rights and content

Abstract

Background & Aims:

People with celiac disease are at risk of developing osteoporosis, but the extent of any increased fracture risk is unclear. We performed a population-based cohort study by using the General Practice Research Database to quantify the fracture risk in people with celiac disease compared with the general population.

Methods:

We identified 4732 people with celiac disease, of whom 1589 were “incident” cases, and 23,620 age- and sex-matched control subjects. We used Cox regression to estimate the hazard ratios for any fracture, hip fracture, and ulna or radius fracture in the celiac disease cohort compared with the general population.

Results:

In the incident subjects with celiac disease, the mean age at diagnosis was 44 years, and 67% were women. The overall hazard ratio for any fracture was 1.30 (95% confidence interval, 1.16–1.46), for hip fracture was 1.90 (95% confidence interval, 1.20–3.02), and for ulna or radius fracture was 1.77 (95% confidence interval, 1.35–2.34). The absolute difference in the overall fracture rate was 3.20 per 1000 person-years and for hip fracture it was 0.97 per 1000 person-years in those older than 45 years. In 1589 incident subjects, the excess fracture risk was slightly lower compared with the “prevalent” subjects (hazard ratio for any fracture, 1.19 vs. 1.40, respectively).

Conclusions:

There were small increases in both the absolute and relative fracture risks in people with celiac disease; the excess risks were slightly lower in those with a more recent diagnosis. Our data indicate that concerns regarding a markedly increased fracture risk in celiac disease are unwarranted.

Section snippets

Materials and methods

In the United Kingdom, more than 95% of people are registered with a general practitioner for their primary health care. The General Practice Research Database (GPRD), established in 1987, is a longitudinal primary care database and contains the computerized medical records from general practice of more than 8 million of these registered people. When people are seen in primary care in the United Kingdom, most significant medical diagnoses, information from hospital letters and discharge

Results

Our cohorts included 4732 subjects with celiac disease and 23,620 matched controls, which contributed 27,116 and 149,896 observed years at risk, respectively. The mean age at diagnosis of the incident subjects with celiac disease was 43.5 years (SD, 21.1 years), and 67% of them were women. The cohorts were closely matched on age at the start of the GPRD record and sex (Table 1). There were more current smokers in the control cohort (15.4% vs. 13.0%) and more individuals who were underweight

Discussion

The results of our study show modest increases in the relative risk of any fracture (30% increase), hip fracture (90% increase), and ulna or radius fracture (77% increase) among people with celiac disease compared with the general population. Nonetheless, the increases in absolute risk of fracture were small: 3.19 fractures per 1000 person-years for any fracture and 0.97 per 1000 person-years in those older than age 45 years for hip fracture alone. These increases in risk were slightly less in

Acknowledgements

The authors thank Hassy Dattani and all the staff at EPIC for their help and advice with General Practice Research Database data, the Wellcome Trust for their grant support, and Laila Jal Tata for her comments on the manuscript.

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    Supported by the Wellcome Trust (grant number 063800). J.W. is a Wellcome Research Training Fellow in Clinical Epidemiology.

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