Anja M Hjelle1,2, Ellen Apalset2,3, Pawel Mielnik1, Roy M Nilsen4, Knut E A Lundin5,6, Grethe S Tell2. 1. a Department of Rheumatology, Division of Medicine , District General Hospital of Førde , Førde , Norway. 2. b Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway. 3. c Bergen group of Epidemiology and Biomarkers in Rheumatic Disease (BeABird), Department of Rheumatology , Haukeland University Hospital , Bergen , Norway. 4. d Faculty of Health and Social Sciences , Western Norway University of Applied Sciences , Bergen , Norway. 5. e Department of Gastroenterology , Oslo University Hospital Rikshospitalet , Oslo , Norway. 6. f KG Jebsen Coeliac Disease Research Centre , University of Oslo , Oslo , Norway.
Abstract
BACKGROUND: Patients with celiac disease (CD), including adults with subclinical disease, have low bone mineral density (BMD), deteriorated bone microarchitecture and meta-analysis show an increased risk of fracture. Immunoglobulin A (IgA) against transglutaminase 2 (IgA TG2) is a highly reliable marker to detect CD. MAIN OBJECTIVE: To explore the prevalence of positive IgA TG2 and CD in patients with distal radius and ankle fracture compared to community-based controls. METHODS: Four hundred patients aged 40 years or above with distal fractures were included in a case-control study. About 197 controls were identified from the National Population Registry, those included had never suffered a fracture. BMD was measured, and comorbidities, medications, physical activity, smoking habits, body mass index (BMI) and nutritional factors were registered. Blood analysis to detect common causes of secondary osteoporosis was performed. RESULTS: About 2.5% of the fracture patients had positive IgA TG2, compared to 1% in the control group. The odds ratio, adjusted for sex and age, of having positive IgA TG2 was 2.50 (95% CI 0.54-11.56). CONCLUSIONS: There were no significantly increased odds of CD in adult patients with fractures compared to controls; however, results imply that positive IgA TG2 is more prevalent in fracture patients than in controls. This study indicates that universal screening for CD in fracture patients is not warranted, but supports current clinical practice in Norway to suspect and investigate for CD in patients with fracture, osteoporosis and other risk factors for CD.
BACKGROUND:Patients with celiac disease (CD), including adults with subclinical disease, have low bone mineral density (BMD), deteriorated bone microarchitecture and meta-analysis show an increased risk of fracture. Immunoglobulin A (IgA) against transglutaminase 2 (IgA TG2) is a highly reliable marker to detect CD. MAIN OBJECTIVE: To explore the prevalence of positive IgA TG2 and CD in patients with distal radius and ankle fracture compared to community-based controls. METHODS: Four hundred patients aged 40 years or above with distal fractures were included in a case-control study. About 197 controls were identified from the National Population Registry, those included had never suffered a fracture. BMD was measured, and comorbidities, medications, physical activity, smoking habits, body mass index (BMI) and nutritional factors were registered. Blood analysis to detect common causes of secondary osteoporosis was performed. RESULTS: About 2.5% of the fracturepatients had positive IgA TG2, compared to 1% in the control group. The odds ratio, adjusted for sex and age, of having positive IgA TG2 was 2.50 (95% CI 0.54-11.56). CONCLUSIONS: There were no significantly increased odds of CD in adult patients with fractures compared to controls; however, results imply that positive IgA TG2 is more prevalent in fracturepatients than in controls. This study indicates that universal screening for CD in fracturepatients is not warranted, but supports current clinical practice in Norway to suspect and investigate for CD in patients with fracture, osteoporosis and other risk factors for CD.
Entities:
Keywords:
Celiac disease; IgA against transglutaminase 2; bone mineral density; fracture; osteoporosis
Authors: Irma J A de Bruin; Lisanne Vranken; Caroline E Wyers; Robert Y van der Velde; Thera A M Trienekens; Sjoerd Kaarsemaker; Heinrich M J Janzing; Frank L Wolters; Siep Wouda; Piet P M M Geusens; Joop P W van den Bergh Journal: Calcif Tissue Int Date: 2020-07-28 Impact factor: 4.333
Authors: Anja M Hjelle; Jan-Erik Gjertsen; Ellen M Apalset; Roy M Nilsen; Anja Lober; Grethe S Tell; Pawel Mielnik Journal: BMC Musculoskelet Disord Date: 2020-12-04 Impact factor: 2.362