Implementation and adherence to osteoporosis screening guidelines among coeliac disease patients.
BACKGROUND
There are no studies evaluating the implementation of American Gastroenterological Association (AGA) guidelines on osteoporosis screening in coeliac disease.


OBJECTIVE
To investigate implementation of osteoporosis screening guidelines in coeliac disease patients and determine how often bone mineral density (BMD) assessment leads to therapeutic intervention.


METHODS
We screened all patients with biopsy-proven coeliac disease at our center from 2003 to 2013 and collected data on indication and results of dual energy X-ray absorptiometry scanning (DXA) and therapeutic interventions.


RESULTS
Of 222 adults with coeliac, only 80 (36%) underwent DXA after their diagnosis. Of those, 43 had DXA for osteoporosis screening specifically related to their coeliac diagnosis. Of these 43 patients, 28 (65.1%) had low BMD. A therapeutic intervention was made in the majority of these patients (21/28, 75%). Of 330 pediatric coeliac cases, 52 (15.8%) had DXA specifically in the context of the coeliac disease diagnosis with only 5 being complicated coeliac disease. Of these, 3 (5.8%) had low BMD and only 2 underwent therapeutic intervention.


CONCLUSIONS
Osteoporosis screening guidelines are not followed in the majority of patients with coeliac disease but, when followed, frequently lead to therapeutic intervention. Osteoporosis screening guidelines in coeliac disease need to be updated, strengthened and publicized.
Department of Medicine, Harvard Medical School, Boston, MA, USA; Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA.
Prashant
P
Singh
Department of Medicine, Harvard Medical School, Boston, MA, USA; Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA. Electronic address: jjgarber@mgh.harvard.edu.
John J
JJ
Garber
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000368:Aged; D015519:Bone Density; D002446:Celiac Disease / Q000150:complications* / Q000473:pathology; D005260:Female; D005762:Gastroenterology; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012955:Societies, Medical; D062606:Tertiary Care Centers; D014481:United States; D055815:Young Adult
Bone mineral density; Coeliac disease; Dual-energy X-ray absorptiometry scanning; Osteopenia; Osteoporosis; Screening