Increased fracture risk among children and adolescents with celiac disease: a nationwide cohort study

Galia Zacay, Ilana Weintrob, Dalit Modan-Moses, Yael Levy-Shraga

Keywords: celiac disease, pediatric fractures, cohort study, epidemiology

Background:

One of the complications of celiac disease (CD) is decreased bone mass. Our aim was to analyze the risk of fractures among children with CD compared with matched children without CD; and to identify clinical and laboratory risk factors to fractures among children with CD.

Research questions:

The aim of the current study was to evaluate the fracture incidence rate of children with celiac disease compared with a large matched healthy population. A second aim was to identify clinical and laboratory risk factors to fractures among children with celiac.

Method:

This registry-based cohort study included 2,372 children with CD and a large, matched comparison group of 11,860 children. Demographic and clinical data, anthropometric measurements and laboratory results were extracted from the electronic database of Meuhedet, a health maintenance organization. Fracture events at ages 1-18 years were identified by coded diagnoses.

Results:

The overall fracture incidence rate was 256 per 10,000 patient-years (PY) in the CD group and 165 per 10,000 PY in the comparison group (p<0.001). Among boys, the fracture incidence rates were 301 per 10,000 PY and 202 per 10,000 PY (p<0.001), for the respective groups; and among girls 224 vs 138 per 10,000 PY, respectively (p<0.001). The stratified hazard ratios (HR) to have a fracture was 1.57 (95%CI 1.43-1.73, p<0.001); and for multiple fractures 1.67, (95%CI 1.38-2.01, p<0.001). Analyze of the periods before and after the diagnosis of CD separately, showed that during the period until the diagnosis, the stratified HR for fractures among children with CD compared to children without celiac was 1.64 (95%CI 1.42-1.88, p<0.001). The stratified HR at the period from the diagnosis to the end of follow-up was 1.46 (95%CI 1.26-1.71, p<0.001).

Conclusions:

Children with CD had greater fracture risk than a matched group without CD both preceding and following the CD diagnosis.

Points for discussion: