Introduction The BSG Guidelines for Osteoporosis in Inflammatory Bowel Disease and Coeliac state there is a definite increased risk of fracture in these conditions and recommend DEXA scanning after introduction of gluten free diet in subgroups of patients where the risk of osteoporotic fracture is high. A 10-year risk of major osteoporotic and hip fracture using the WHO Fracture Risk Assessment Score (FRAX) can be calculated in patients with coeliac disease and this score mapped to the National Osteoporosis Guideline Group (NOGG) assessment tool may be better to decide the need for a DEXA scan.
Methods The aim of this study was to determine if the WHO FRAX can be used to screen patients with Coeliac disease to decide who needed a DEXA scan, and make pathways more cost effective. A retrospective analysis of all duodenal biopsies in our Trust between June 2010 and April 2011 was undertaken and 50 definitive pathological diagnoses of coeliac disease that is, Marsh stage 1 to 4 were identified. The notes of these patients were reviewed to see if a DEXA scan had been requested and to calculate their FRAX score with and without a BMD measurement.
Results Of 50 patients with a definitive pathological diagnosis of coeliac disease, 33 were female and 17 male. The median age at diagnosis was 45, with 30 (60%) of patients aged between 42 and 71 yrs, making them eligible for the FRAX score. Documentation of smoking status, alcohol history, use of corticosteroids, past medical history and family history of fracture was done for most patients. Of the 30 patients, 13 had already had a DEXA scan; in two pts a FRAX score was unable to be calculated due to information not being documented. 17 had not had a DEXA scan; seven of these were unable to be FRAX scored due to information not being documented. 11 patients had both FRAX scores and DEXA scores: 4 had T scores <−2.5, indicating eligibility for treatment of osteoporosis. In these patients FRAX scores, without a BMD measurement, ranged from 6.1% to 13% for a major osteoporotic fracture and 0.9% to 6.6% for a hip fracture. In the seven patients with T scores >−2.5, FRAX scores, without a BMD measurement, ranged from 3.1%>9.5% for a major osteoporotic fracture and 0.2%>1.8% for a hip fracture.
Conclusion The majority of coeliac patients in this study were females, over the age of 40. Coeliac patients, over the age of 40, with FRAX scores for a major osteoporotic fracture >9.5% and for a hip fracture >1.8% may need DEXA scans and be offered osteoporosis treatment. A cost effectiveness analysis of this strategy is needed to change the current guidance.
Competing interests E Derbyshire: None Declared, A Dhar Speaker bureau with: Several Pharmaceutical Companies, Conflict with: Honoraria from Pharmaceutical and endoscopy industry.
References 1. http://www.shef.ac.uk/FRAX
2. Scott EM, Gaywood I, Scott BB, et al. BSG Guidelines for Osteoporosis in Coeliac Disease and Inflammatory Bowel Disease. 2000.
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