title: Risk of fracture in celiac disease: gender, dietary compliance, or both?
abstract: OBJECTIVE
  To determine the incidence of peripheral fractures in patients with celiac disease (CD) and the effect of treatment on fracture risk.
  
  
  METHODS
  We compared the incidence and risk of peripheral fractures before and after diagnosis between a cohort of 265 patients who had been diagnosed with CD at least 5 years before study entry and a cohort of 530 age- and sex-matched controls who had been diagnosed with functional gastrointestinal disorders. Data were collected through in-person interviews with an investigator. The overall assessment window for patients was 9843 patient-years (2815 patient-years after diagnosis).
  
  
  RESULTS
  Compared with the control group, the CD cohort showed significantly higher incidence rate and risk of first peripheral fracture before diagnosis [adjusted hazard ratio (HR): 1.78, 95% CI: 1.23-2.56, P < 0.002] and in men (HR: 2.67, 95% CI: 1.37-5.22, P < 0.004). Fracture risk was significantly associated with the classic CD presentation with gastrointestinal symptoms (P < 0.003). In the time period after diagnosis, the risk of fractures was comparable between the CD cohort and controls in both sexes (HR: 1.08, 95% CI: 0.55-2.10 for women; HR: 1.57, 95% CI: 0.57-4.26 for men).
  
  
  CONCLUSIONS
  CD patients have higher prevalence of fractures in the peripheral skeleton before diagnosis. This is associated with male sex and classic clinical presentation. The fracture risk was reduced after the treatment.
authors.affiliation: Small Bowel Section, Department of Medicine, "Dr. C. Bonorino Udaondo" Gastroenterology Hospital, 1264 Buenos Aires, Argentina.
authors.forename: María Inés Pinto
authors.initials: MI
authors.lastname: Sánchez
authors.forename: Adriana
authors.initials: A
authors.lastname: Mohaidle
authors.forename: Andrea
authors.initials: A
authors.lastname: Baistrocchi
authors.forename: Dolores
authors.initials: D
authors.lastname: Matoso
authors.forename: Horacio
authors.initials: H
authors.lastname: Vázquez
authors.forename: Andrea
authors.initials: A
authors.lastname: González
authors.forename: Roberto
authors.initials: R
authors.lastname: Mazure
authors.forename: Evangelina
authors.initials: E
authors.lastname: Maffei
authors.forename: Guillermina
authors.initials: G
authors.lastname: Ferrari
authors.forename: Edgardo
authors.initials: E
authors.lastname: Smecuol
authors.forename: Adriana
authors.initials: A
authors.lastname: Crivelli
authors.forename: Juan Andrés
authors.initials: JA
authors.lastname: de Paula
authors.forename: Juan C
authors.initials: JC
authors.lastname: Gómez
authors.forename: Silvia
authors.initials: S
authors.lastname: Pedreira
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mauriño
authors.forename: Julio César
authors.initials: JC
authors.lastname: Bai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000178:diet therapy* / Q000503:physiopathology; D015331:Cohort Studies; D004032:Diet; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult