Case-finding for adult celiac disease in patients with reduced bone mineral density.
The aim of this study was to assess the value of case-finding for unrecognized adult celiac disease (CD) in patients with reduced bone mineral density (BMD), verified by dual-energy X-ray absorptiometry (DXA). Patients attending for a DXA scan were investigated for CD using immunoglobulins, IgG/IgA antigliadin antibodies (AGA), and endomysial antibodies (EMA). All patients with a positive IgA AGA, EMA, or only IgG AGA in the presence of IgA deficiency had a small bowel biopsy. There were 12 cases of CD (12/978), a prevalence of 1.2% for the whole cohort. The prevalence of CD was 0.7% (2/304) for those with a normal BMD, 1.2% (5/431) for patients with osteopenia, and 2.1% (5/243) for patients with osteoporosis. Direct questioning revealed that all patients with unrecognized CD had subtle gastrointestinal symptoms or a history of anemia. Excluding patients without these symptoms would give a prevalence of 3.9% for osteoporosis (5/127) and 2.6% for osteopenia (5/191 ). This study suggests that there is no value of unselected case-finding for CD in patients with a reduced BMD. However, a targeted case-finding approach may be more valid and cost-effective with the initial selection of patients who should be investigated for CD based on questioning about gastrointestinal symptoms or anemia.
Sanders
David S
DS
Royal Hallamshire Hospital, Sheffield, UK. d.s.sanders28@btopenworld.com
Patel
Dina
D
Khan
Fozia B
FB
Westbrook
Rachel H
RH
Webber
Chloe V
CV
Milford-Ward
Anthony
A
McCloskey
Eugene V
EV
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D015519:Bone Density / Q000502:physiology; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003720:Densitometry; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000453:epidemiology*; D018579:Patient Selection; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D017678:Sex Distribution