Celiac disease is associated with reduced bone mineral density and increased FRAX scores in the US National Health and Nutrition Examination Survey.

Abstract

Celiac disease (CD) is an autoimmune condition, characterized by inflammation of the small intestine. CD has an increasing prevalence, and if unrecognized or untreated, CD can lead to complications from malabsorption and micronutrient deficiencies. We aimed to study whether CD is an independent predictor of reduced bone mineral density (BMD) and FRAX scores in the general US population. We used data from the National Health and Nutrition Examination Survey, 2009-2010 and 2013-2014. CD was defined by positive tissue transglutaminase IgA antibody test. Multivariable models of BMD and FRAX scores were adjusted for BMI, serum 25-hydroxyvitamin D, vitamin D and calcium supplements, milk intake, serum calcium, and smoking status, when available. In children, aged 8-17years, CD was associated with decreased Z-scores, by 0.85 for hip and 0.46 for spine (both P<0.001). In men aged≥18years, CD was associated with 0.06g/cm2 decrease in BMD in hip and with 0.11g/cm2 decrease in BMD in spine (P=0.08 and P<0.001, respectively). In women, there were no statistically significant differences in the multiple-adjusted model. In men aged ≥40years, CD predicted FRAX scores, resulting in increased scores by 2.25% (P=0.006) for hip fracture and by 2.43% (P=0.05) for major osteoporotic fracture. CD did not predict FRAX scores in women aged ≥40years. CD is independently associated with reduced BMD in children and adults aged ≥18years and is an independent risk factor of osteoporotic fractures in men aged ≥40years.