Self-Reported Fractures in Dermatitis Herpetiformis Compared to Coeliac Disease.

Camilla Pasternack,Kaisa Hervonen,Eriika Mansikka,Teea Salmi,Timo Reunala,Heini Huhtala,Katri Kaukinen,Pekka Collin,Ville Mattila

doi:10.3390/nu10030351

Camilla Pasternack, Kaisa Hervonen + Show 7 more

Open Access

https://doi.org/10.3390/nu10030351

Copy DOI

Journal: Nutrients	Publication Date: Mar 14, 2018
Citations: 8	License type: CC BY 4.0

Affiliation: Tampere University, Tampere University Hospital

Abstract

Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. Increased bone fracture risk is known to associate with coeliac disease, but this has been only scantly studied in DH. In this study, self-reported fractures and fracture-associated factors in DH were investigated and compared to coeliac disease. Altogether, 222 DH patients and 129 coeliac disease-suffering controls were enrolled in this study. The Disease Related Questionnaire and the Gastrointestinal Symptom Rating Scale and Psychological General Well-Being questionnaires were mailed to participants; 45 out of 222 (20%) DH patients and 35 out of 129 (27%) of the coeliac disease controls had experienced at least one fracture (p = 0.140). The cumulative lifetime fracture incidence did not differ between DH and coeliac disease patients, but the cumulative incidence of fractures after diagnosis was statistically significantly higher in females with coeliac disease compared to females with DH. The DH patients and the coeliac disease controls with fractures reported more severe reflux symptoms compared to those without, and they also more frequently used proton-pump inhibitor medication. To conclude, the self-reported lifetime bone fracture risk is equal for DH and coeliac disease. After diagnosis, females with coeliac disease have a higher fracture risk than females with DH.

Highlights

Coeliac disease is a systemic autoimmune disorder triggered by gluten and characterized by small-bowel mucosal villous atrophy
The Dermatitis herpetiformis (DH) patients and the coeliac disease controls reported a total of 128 fractures, of which 9 excess-trauma fractures and 5 stress fractures were excluded from further analysis
This study showed that the DH patients who reported fractures had a decreased quality of life compared to those with no fractures

Summary

Introduction

Coeliac disease is a systemic autoimmune disorder triggered by gluten and characterized by small-bowel mucosal villous atrophy. It has a highly heterogeneous clinical picture including intestinal, extraintestinal, and asymptomatic manifestations [1]. At the time of diagnosis, coeliac disease patients frequently suffer from decreased bone mineral density (BMD) [2,3], which in turn may be a risk factor for fractures. Decreased BMD is not limited to only patients with severe gastrointestinal symptoms; it occurs in subclinical and asymptomatic coeliac disease patients [4,5,6]. Coeliac disease is treated with a life-long gluten-free diet (GFD)

Objectives

Methods

Results

Discussion

Conclusion