title: Fracture risk in people with celiac disease: a population-based cohort study.
abstract: OBJECTIVE
  People with celiac disease are at risk of developing osteoporosis, but the extent of any increased fracture risk is unclear. We performed a population-based cohort study by using the General Practice Research Database to quantify the fracture risk in people with celiac disease compared with the general population.
  
  
  METHODS
  We identified 4732 people with celiac disease, of whom 1589 were "incident" cases, and 23,620 age- and sex-matched control subjects. We used Cox regression to estimate the hazard ratios for any fracture, hip fracture, and ulna or radius fracture in the celiac disease cohort compared with the general population.
  
  
  RESULTS
  In the incident subjects with celiac disease, the mean age at diagnosis was 44 years, and 67% were women. The overall hazard ratio for any fracture was 1.30 (95% confidence interval, 1.16-1.46), for hip fracture was 1.90 (95% confidence interval, 1.20-3.02), and for ulna or radius fracture was 1.77 (95% confidence interval, 1.35-2.34). The absolute difference in the overall fracture rate was 3.20 per 1000 person-years and for hip fracture it was 0.97 per 1000 person-years in those older than 45 years. In 1589 incident subjects, the excess fracture risk was slightly lower compared with the "prevalent" subjects (hazard ratio for any fracture, 1.19 vs. 1.40, respectively).
  
  
  CONCLUSIONS
  There were small increases in both the absolute and relative fracture risks in people with celiac disease; the excess risks were slightly lower in those with a more recent diagnosis. Our data indicate that concerns regarding a markedly increased fracture risk in celiac disease are unwarranted.
authors.affiliation: University of Nottingham, Division of Epidemiology and Public Health, Queen's Medical Centre, Nottingham, UK. joe.west@nottingham.ac.uk
authors.forename: Joe
authors.initials: J
authors.lastname: West
authors.forename: Richard F A
authors.initials: RF
authors.lastname: Logan
authors.forename: Tim R
authors.initials: TR
authors.lastname: Card
authors.forename: Chris
authors.initials: C
authors.lastname: Smith
authors.forename: Richard
authors.initials: R
authors.lastname: Hubbard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012306:Risk