The Prevalence of Celiac Disease in a Fracture Liaison Service Population

Irma J A De Bruin,Siep Wouda,Thera A M Trienekens,Sjoerd Kaarsemaker,Heinrich M J Janzing,Joop P W Van Den Bergh,Robert Y Van Der Velde,Lisanne Vranken,Piet P M M Geusens,Caroline E Wyers,Frank L Wolters

doi:10.1007/s00223-020-00725-z

Abstract

Celiac disease (CD) is a known risk factor for osteoporosis and fractures. The prevalence of CD in patients with a recent fracture is unknown. We therefore systematically screened patients at a fracture liaison service (FLS) to study the prevalence of CD. Patients with a recent fracture aged ≥ 50 years were invited to VieCuri Medical Center’s FLS. In FLS attendees, bone mineral density (BMD) and laboratory evaluation for metabolic bone disorders and serological screening for CD was systematically evaluated. If serologic testing for CD was positive, duodenal biopsies were performed to confirm the diagnosis CD. Data were collected in 1042 consecutive FLS attendees. Median age was 66 years (Interquartile range (IQR) 15), 27.6% had a major and 6.9% a hip fracture, 26.4% had osteoporosis and 50.8% osteopenia. Prevalent vertebral fractures were found in 29.1%. CD was already diagnosed in two patients (0.19%), one still had a positive serology. Three other patients (0.29%) had a positive serology for CD (one with gastro-intestinal complaints). In two of them, CD was confirmed by duodenal histology (0.19%) and one refused further evaluation. The prevalence of biopsy-proven CD was therefore 0.38% (4/1042) of which 0.19% (2/1042) was newly diagnosed. The prevalence of CD in patients with a recent fracture at the FLS was 0.38% and within the range of reported prevalences in the Western-European population (0.33–1.5%). Newly diagnosed CD was only found in 0.19%. Therefore, standard screening for CD in FLS patients is not recommended.

Highlights

Celiac disease (CD) is an autoimmune enteropathy induced by dietary proteins in wheat, rye, and barley
Besides screening for osteoporosis, screening for metabolic bone disorders is recommended in fracture liaison service (FLS) patients [21,22,23,24]
Since IgA deficiency is more prevalent in patients with CD than in the general population, IgA was evaluated in all patients in addition to anti-tissue transglutaminase antibodies (tTG) IgA [31]

Summary

Introduction

Celiac disease (CD) is an autoimmune enteropathy induced by dietary proteins in wheat, rye, and barley. Oslo definitions for CD were stated: ‘classical CD presents with signs and symptoms of malabsorption. Other symptoms of diarrhea, steatorrhea, weight loss, or growth failure are required. Non-classical CD presents with gastro-intestinal symptoms and extra intestinal. Manifestations, but without signs and symptoms of malabsorption and diarrhea. Subclinical CD is disease below the threshold of clinical detection without signs or symptoms sufficient to trigger CD testing in routine practice’ [1]. It was demonstrated that in a period of 15 years (1998–2012) an increasing part of the CD patients had a subclinical CD or a non-classical phenotype instead of the classical CD phenotype [2]

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