title: Celiac disease and bone fractures: a systematic review and meta-analysis.
abstract: BACKGROUND
  Celiac disease, an autoimmune disease induced by dietary gluten, is associated with metabolic bone disorders, such as low bone mineral density. However, it is unclear whether this translates into an association between celiac disease and such hard clinical outcomes as bone fractures.
  
  
  OBJECTIVE
  To systematically review and pool the evidence for the relationship of celiac disease with prevalence and incidence of bone fractures.
  
  
  METHODS
  We systematically searched Pubmed, Scopus, Web of Science, and Cochrane Library in January 2014 for studies of celiac disease and bone fractures.
  
  
  METHODS
  Observational studies of any design, in which bone fracture outcomes were compared in individuals with and without celiac disease were included.
  
  
  METHODS
  Two investigators independently extracted results from eligible studies.
  
  
  RESULTS
  In the meta-analyses of case-control and cross-sectional studies, bone fractures were almost twice as common in individuals with a clinically diagnosed celiac disease as in those without the disease. In the meta-analyses of prospective studies, celiac disease at baseline was associated with a 30% increase (95% confidence interval [CI]: 1.14, 1.50) in the risk of any fracture and a 69% increase in the risk of hip fracture (95% CI: 1.10, 2.59). The two studies of unrecognized celiac disease (elevated circulating concentrations of celiac disease-specific autoantibodies but no celiac disease diagnosis) had contradicting findings.
  
  
  CONCLUSIONS
  Our findings suggest that clinically diagnosed celiac disease and bone fractures co-occur and that celiac disease was associated with an increased risk of hip fractures as well as fractures in general. Further research would be needed to determine whether unrecognized celiac disease is associated with the risk of bone fractures.
authors.affiliation: School of Medicine (K.H., K.K.), University of Tampere, Tampere 33520, Finland; Division of Nutritional Sciences (J.P.), School of Biosciences, University of Nottingham, Nottingham LE12 5RD, United Kingdom; Tampere Centre for Child Health Research (M.M.), University of Tampere and Tampere University Hospital, Tampere 33520, Finland; Department of Internal Medicine (K.K.), Tampere University Hospital, Tampere 33520, Finland; Department of Internal Medicine (K.K.), Seinäjoki Central Hospital, Seinäjoki 60220, Finland.
authors.forename: Katriina
authors.initials: K
authors.lastname: Heikkilä
authors.forename: Jo
authors.initials: J
authors.lastname: Pearce
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
mesh_terms: D015519:Bone Density; D002446:Celiac Disease / Q000453:epidemiology*; D015897:Comorbidity; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D015995:Prevalence