title: Stratification of bone fracture risk in patients with celiac disease.
abstract: OBJECTIVE
  Our objective in this cross-sectional, case-control study was to gain insight into celiac osteopathy by examining a well-defined cohort of patients with a wide clinical spectrum of the disease.
  
  
  METHODS
  We studied 148 unselected celiac patients and 296 (1:2) age- and sex-matched controls diagnosed with functional gastrointestinal disorders. Based on the clinical history, 53% were classically symptomatic, 36% had subclinical celiac disease, and 11% were silent, detected by screening. The fracture information was obtained through an in-person interview using a pre-designed questionnaire.
  
  
  RESULTS
  Classically symptomatic patients had an increased number of fractures in the peripheral skeleton (47%) compared with age- and sex-matched controls (15%; odds ratio, 5.2; 95% confidence interval, 2.8-9.8). However, fractures in subclinical/silent celiac cases (20%) were no different from those in controls (14%; odds ratio, 1.7, 0.7-4.4). Compared with the subclinical/silent group, a significantly greater prevalence of fractures was detected in classically symptomatic patients (odds ratio, 3.6, 1.7-7.5). Compared with controls, celiac disease patients had significantly more fractures produced by mild trauma (P < 0.01), but there were no differences in the severity of trauma events that induced fractures. Mean bone density femoral neck z score was higher for subclinical/silent cases compared with classically symptomatic patients (P < 0.05).
  
  
  CONCLUSIONS
  Celiac patients show a very wide variation in fracture risk, with increased risk in classically symptomatic patients. Diagnostic and therapeutic strategies to prevent bone loss and fracture should be preferentially used in the subgroup of patients with classic clinical disease.
authors.affiliation: Small Intestine Section, Department of Medicine, Hospital de Gastroenterologa Dr. Carlos Bonorino Udaondo, Buenos Aires, and School of Medicine, Universidad del Salvador, Buenos Aires, Argentina.
authors.forename: Mara L
authors.initials: ML
authors.lastname: Moreno
authors.forename: Horacio
authors.initials: H
authors.lastname: Vazquez
authors.forename: Roberto
authors.initials: R
authors.lastname: Mazure
authors.forename: Edgardo
authors.initials: E
authors.lastname: Smecuol
authors.forename: Sonia
authors.initials: S
authors.lastname: Niveloni
authors.forename: Silvia
authors.initials: S
authors.lastname: Pedreira
authors.forename: Emilia
authors.initials: E
authors.lastname: Sugai
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mauriño
authors.forename: Juan C
authors.initials: JC
authors.lastname: Gomez
authors.forename: Julio C
authors.initials: JC
authors.lastname: Bai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015519:Bone Density / Q000502:physiology; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D002648:Child; D003430:Cross-Sectional Studies; D003720:Densitometry; D018572:Disease-Free Survival; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D015995:Prevalence; D011859:Radiography; D012307:Risk Factors