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Celiac.com 01/28/2019 - Research shows that people with celiac disease have an increased risk of bone fractures, compared to the regular population, but there's not much good data on fracture risk in patients with dermatitis herpetiformis. A team of researchers recently compared self-reported bone fractures in patients with dermatitis herpetiformis against those with celiac disease. The research team included C Pasternack, E Mansikka, K Kaukinen, K Hervonen, T Reunala, P Collin, H Huhtala, VM Mattila, and T Salmi. In all, they looked at self-reported fracture rates in 222 dermatitis herpetiformis patients, and in 129 control subjects with celiac disease. The team provided a Disease Related Questionnaire and the Gastrointestinal Symptom Rating Scale and Psychological General Well-Being questionnaires to study members. They received 45 replies from the 222 dermatitis herpetiformis patients, and 35 replies from the 129 celiac disease control subjects. All patients had experienced at least one fracture. Overall, cumulative lifetime fracture rates were about the same for both dermatitis herpetiformis and celiac disease patients. Fractures More Common in Women with Celiac Disease However, when the team looked at the cumulative incidence of fracture after disease diagnosis, they found a significantly higher risk in women with celiac disease than in women with dermatitis herpetiformis. Acid Reflux and Proton-Pump Inhibitor Connection Interestingly, both dermatitis herpetiformis and celiac disease patients with fractures reported more severe reflux symptoms compared to those without. Dermatitis herpetiformis and celiac disease patients with fractures also reported using more proton-pump inhibitor medication. More research needs to be done to explore this connection. To sum it up, self-reported lifetime bone fracture risk is about the same for both DH and celiac disease patients. However, after diagnosis, fracture risk is higher in women with celiac disease than in women with dermatitis herpetiformis. This means that women with celiac disease need to work with doctors to keep a tight eye on bone integrity, even when eating a gluten-free diet. Source: Nutrients. 2018 Mar 14;10(3). pii: E351. doi: 10.3390/nu10030351

Celiac.com 10/23/2020 - As people age, their bones become less dense, and their risk of developing osteoporosis, leaving them susceptible to fractures. A recent study indicates that celiac disease may increase that risk, even in younger people. According to the Canadian study, people with celiac disease have a higher risk of serious osteoporotic fracture that is unrelated to their fracture risk assessment tool (FRAX) score. FRAX scores accurately predict fracture risk when celiac disease is added as a secondary osteoporosis risk factor, or when BMD is included in the FRAX assessment. A research team used data from the Manitoba Bone Mineral Density Registry to determine the 10-year risk of major osteoporotic fractures in nearly 700 people with celiac disease, over a period of about seven years. They also followed just over 68,000 people from the general population subjects for a similar period. The research team included D.R. Duerksen, L.M. Lix, H. Johansson, E.V. McCloskey, N.C. Harvey, J.A. Kanis & W.D. Leslie. The team found that about 8.5 percent of people in each group suffered one or more major osteoporotic fractures, even though the celiac disease group was younger, and contained more men. In the general population, there FRAX predictions and the observed 10-year major osteoporotic fracture probabilities matched up cleanly. In patients with celiac disease, however, predicted and observed fracture predictions only aligned when celiac disease was factored as secondary osteoporosis; otherwise, FRAX underestimated the celiac patients' 10-year major fracture risk by more than 4 percent. Celiac disease patients face an increased risk of major osteoporotic fractures. When celiac disease is considered as a secondary osteoporosis risk factor, or when BMD is included in FRAX assessment, FRAX can accurately predict future fracture risk. Do you have celiac disease and also suffer from osteoporosis? Have you broken bones? Share your thoughts below. Read more in Osteoporosis International (2020)

Celiac.com 12/24/2018 - People with celiac disease, including adults with subclinical celiac disease, have low bone mineral density (BMD), deteriorated bone microarchitecture and meta-analysis show an increased risk of fracture. Immunoglobulin A (IgA) against transglutaminase 2 (IgA TG2) is a highly reliable marker to detect celiac disease. A team of researchers recently set out to explore the prevalence of positive IgA TG2 and celiac disease in patients with distal radius and ankle fracture compared to community-based controls. For their study case-controlled study, the researchers enrolled our hundred patients aged 40 years or above with distal fractures. The team used the National Population Registry to identify about 197 control subjects who had never suffered a fracture. The team measured BMD, and noted any comorbidities, medications, physical activity, smoking habits, body mass index (BMI) and nutritional factors. Blood analysis to detect common causes of secondary osteoporosis was performed. They found that about 2.5% of the fracture patients had positive IgA TG2, compared to 1% in the control group. The odds ratio, adjusted for sex and age, of having positive IgA TG2 was 2.50 (95% CI 0.54–11.56). They found that patients with fractures had no significantly greater odds of celiac disease than control subjects. However, results do indicate that positive IgA TG2 is more common in fracture patients than in control subjects. This study does not point to any need for universal screening for celiac disease in fracture patients, but it does support the current clinical practice in Norway of looking for celiac disease in patients with fracture, osteoporosis and other risk factors for celiac disease. Read more at Tandfonline.com https://doi.org/10.1080/00365521.2018.1509122 The research team included Anja M. Hjelle, Ellen Apalset, Pawel Mielnik, Roy M. Nilsen, Knut E. A. Lundin & Grethe S. Tell. They are variously affiliated with the the Department of Rheumatology, Division of Medicine, District General Hospital of Førde, Førde, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; the Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; the Bergen group of Epidemiology and Biomarkers in Rheumatic Disease (BeABird), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway; the Department of Rheumatology, Division of Medicine, District General Hospital of Førde, Førde, Norway; the Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; the Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway; KG Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway; and the Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

Celiac.com 11/17/2014 - There is a large body of data that show that celiac disease is associated with metabolic bone disorders, such as low bone mineral density. However, it is unclear whether this translates into an association between celiac disease and such hard clinical outcomes as bone fractures. A research team set out to systematically review and pool the data to better understand the nature of the relationship between celiac disease and the prevalence and incidence of bone fractures. The research team included Katriina Heikkilä, Jo Pearce, Markku Mäki, and Katri Kaukinen. They are variously affiliated with the Departments of Internal Medicine at Seinäjoki Central Hospital and Tampere University Hospital, Finland, the School of Medicine at the University of Tampere, Finland, the Tampere Centre for Child Health Research at University of Tampere and Tampere University Hospital, Finland, and with the Division of Nutritional Sciences, School of Biosciences at the University of Nottingham in the United Kingdom. For their study, they conducted a systematic search of Pubmed, Scopus, Web of Science and Cochrane Library in January 2014 for studies of celiac disease and bone fractures. They included observational studies of any design which compared bone fracture outcomes in individuals with and without celiac disease. Two investigators then independently gathered results from eligible studies. A meta-analyses of case-control and cross-sectional studies showed that bone fractures were almost twice as common in individuals with a clinically diagnosed celiac disease as in those without celiac disease. A meta-analyses of prospective studies showed that celiac disease at baseline was associated with a 30% increase (95% CI: 1.14, 1.50) in the risk of any fracture and a 69% increase in the risk of hip fracture (95% CI: 1.10, 2.59). Two studies of patients with high concentrations of celiac disease-specific autoantibodies, but no celiac disease diagnosis, produced contradictory findings. The results of this study suggest that people with clinically diagnosed celiac disease face a greatly increased risk of hip fractures, and of fractures in general. Further research is needed to determine whether unrecognized celiac disease carries a similar risk of bone fractures. Source: The Journal of Clinical Endocrinology & Metabolism. DOI: http://dx.doi.org/10.1210/jc.2014-1858

Celiac.com 02/19/2014 - Celiac disease have a greater risk of bone fracture than non-celiacs; a risk that persists after diagnosis. Also a substantial number of celiac patients display signs of persistent villous atrophy on follow-up biopsy. A team of researchers recently set out to determine whether persistent villous atrophy impacts long-term fracture risk. The research team included Benjamin Lebwohl, Karl Michaëlsson, Peter H. R. Green and Jonas F. Ludvigsson. They are variously affiliated with the Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; the Clinical Epidemiology Unit of the Department of Medicine at Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden; the Department of Surgical Sciences, Section of Orthopaedics at Uppsala University in Upsalla Sweden; and Department of Pediatrics at Örebro University Hospital in Örebro, Sweden. First, the team identified all patients in Sweden with histological evidence of celiac disease who underwent a follow-up biopsy and compared patients with persistent villous atrophy with those with mucosal healing. The team then recorded data for all known general fractures; for likely osteoporotic fractures (of hip, distal forearm, thoracic and lumbar spine, or proximal humerus); and all known hip fractures. Follow-up biopsies showed villous atrophy in 43% of the 7,146 patients. The results showed no significant connection between persistent villous atrophy and overall fractures. The hazard ratio (HR) for persistent villous atrophy compared with those with healing was 0.93, with a 95% confidence interval (CI 0.82–1.06). Nor was there a connection between persistent villous atrophy and likely osteoporotic fractures (HR 1.11, 95% CI 0.84–1.46). Results did show that persistent villous atrophy was connected with an increased risk of hip fracture (HR 1.67, 95% CI 1.05–2.66). The risk of hip fracture rose in relation to the degree of villous atrophy; the more villous atrophy, the higher the risk of hip fracture. Overall, HR for partial villous atrophy compared with those with healing was 1.70, with a 95% CI 0.82–3.49 (HR for subtotal/total villous atrophy compared with those with healing 2.16, 95% CI 1.06–4.41). The results indicate that persistent villous atrophy on follow-up biopsy can be used to predict the risk of hip fracture in patients with celiac disease. The connection between persistent villous atrophy and hip fractures, but not fractures overall, implies that the increased fracture risk is due to thinner sc tissue, and fall or trauma. Source: The Journal of Clinical Endocrinology & Metabolism. DOI: http://dx.doi.org/10.1210/jc.2013-3164

Celiac.com 11/23/2011 - Osteopenia and osteoporosis, both conditions in which bone density is less than optimal, are often seen in people with celiac disease at the time of their diagnosis. There have been conflicting data as to whether a gluten free diet can improve bone density. Researchers in Argentina set out to determine if celiac patients suffer more peripheral fractures than a control population, and to assess the effects of a gluten free diet on fracture risk. Their results are reported in the July 7, 2011 issue of the World Journal of Gastroenterology. They recruited 256 people who had been diagnosed with celiac at least five years before the study began in March, 2007, asked them if they had ever broken any bones and, if so, which. They then compared their answers to answers obtained from 530 age- and sex- matched controls with functional gastrointestinal disorders. People with other disorders that could reduce bone health – like thyroid dysfunction, rheumatoid arthritis, inflammatory bowel disease, and diabetes – as well as those taking vitamin D, steroids, calcium supplements or other medications that could affect bone metabolism were excluded. They found that celiacs had a higher rate and risk of first peripheral fracture before diagnosis – but this effect only achieved statistical significance for men. This increased risk was also associated with a classical clinical presentation; those with atypical or silent forms of celiac did not exhibit the same risk. Although the finding that being male increases a celiac’s risk of peripheral fractures is intriguing, it must be borne out by larger studies – only 42 of the 256 celiacs included in this study were male. After maintaining a gluten free diet for five years, the elevated risk of fractures was gone. The authors speculate that eliminating gluten may reduce the risk of fractures in celiac patients not necessarily by increasing bone mass and mineral density, but by improving body mass and fat/ muscle composition, nutritional status, and bone architecture. Despite its limited scope, the take home message of this study is clear; if you have celiac disease, strictly adhering to a gluten free diet is good not just for your intestines, immune system, and skin; it is also good for your bones. Source: Sanchez et al. Risk of fracture in celiac disease: Gender, dietary compliance, or both? World J. Gastroenterol 2011 July 7; 17(25).