title: Celiac disease is associated with reduced bone mineral density and increased FRAX scores in the US National Health and Nutrition Examination Survey.
abstract: We investigated the association between celiac disease (CD) and bone mass density (BMD) and risk of osteoporotic fractures in the general US population. In children and men ≥18 years, CD was associated with reduced BMD, and in men ≥40 years, CD was associated with increased risk of osteoporotic fractures.
  
  
  
  Celiac disease (CD) is an autoimmune condition, characterized by inflammation of the small intestine. CD has an increasing prevalence, and if unrecognized or untreated, CD can lead to complications from malabsorption and micronutrient deficiencies. We aimed to study whether CD is an independent predictor of reduced bone mineral density (BMD) and FRAX scores in the general US population.
  
  
  
  We used data from the National Health and Nutrition Examination Survey, 2009-2010 and 2013-2014. CD was defined by positive tissue transglutaminase IgA antibody test. Multivariable models of BMD and FRAX scores were adjusted for BMI, serum 25-hydroxyvitamin D, vitamin D and calcium supplements, milk intake, serum calcium, and smoking status, when available.
  
  
  
  In children, aged 8-17 years, CD was associated with decreased Z-scores, by 0.85 for hip and 0.46 for spine (both P < 0.001). In men aged ≥ 18 years, CD was associated with 0.06 g/cm2decrease in BMD in hip and with 0.11 g/cm2decrease in BMD in spine (P = 0.08 and P < 0.001, respectively). In women, there were no statistically significant differences in the multiple-adjusted model. In men aged ≥ 40 years, CD predicted FRAX scores, resulting in increased scores by 2.25 % (P = 0.006) for hip fracture and by 2.43 % (P = 0.05) for major osteoporotic fracture. CD did not predict FRAX scores in women aged ≥40 years.
  
  
  
  CD is independently associated with reduced BMD in children and adults aged ≥18 years and is an independent risk factor of osteoporotic fractures in men aged ≥40 years.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St, Suite 920, Boston, MA, 02114, USA. elena.kamycheva@unn.no.|Medical Clinic, University Hospital of North Norway, Sykehusveien 38, 9038, Tromsoe, Norway. elena.kamycheva@unn.no.|Endocrine Research Group, Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9017, Tromsoe, Norway. elena.kamycheva@unn.no.
authors.forename: E
authors.identifier: http://orcid.org/0000-0003-0642-5125
authors.initials: E
authors.lastname: Kamycheva
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St, Suite 920, Boston, MA, 02114, USA.|Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: T
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St, Suite 920, Boston, MA, 02114, USA.|Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015519:Bone Density; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology; D002648:Child; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology*; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology*; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Bone mineral density; Celiac disease; FRAX score; NHANES; Osteoporosis