Clinical-alimentary tractFracture risk in people with celiac disease: a population-based cohort study☆
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.
References (30)
- et al.
Osteoporosis in adult patients with celiac disease
Bone
(1999) - et al.
Birth outcomes of women with celiac diseasea nationwide historical cohort study
Am J Gastroenterol
(1999) - et al.
Cancer incidence in a population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis
Gastroenterology
(2002) - et al.
AGA technical review on osteoporosis in gastrointestinal diseases
Gastroenterology
(2003) - et al.
Epidemiology of fractures in England and Wales
Bone
(2001) - et al.
Trends in the identification and clinical features of celiac disease in a North American Community, 1950-2001
Clin Gastroenterol Hepatol
(2003) - et al.
Malignancy in coeliac disease—effect of a gluten free diet
Gut
(1989) - et al.
Coeliac disease and unfavourable outcome of pregnancy
Gut
(2000) Bone mineral density in coeliac disease
Gut
(1994)- et al.
Risk of non-Hodgkin lymphoma in celiac disease
JAMA
(2002)
Reversal of osteopenia with diet in adult coeliac disease
Gut
Three years’ follow-up of bone density in adult coeliac diseasesignificance of secondary hyperparathyroidism
Scand J Gastroenterol
Osteoporosis in treated adult coeliac disease
Gut
medical position statementceliac Sprue
Gastroenterology
Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease
Gut
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Supported by the Wellcome Trust (grant number 063800). J.W. is a Wellcome Research Training Fellow in Clinical Epidemiology.