0347: Identifying Risk Factors for Fragility Fractures in Patients with Coeliac Disease: An Observational Study

Background/Purpose: Coeliac disease (CD) is an autoimmune disease, which has been widely reported to be associated with reduced bone mineral density (BMD), leading to an increased risk of fragility fractures. The lower bone mineral density observed in coeliac disease patients may be attributed to several factors including malabsorption, vitamin D deficiency, chronic inflammation, and associations with inflammatory conditions such as osteoporosis or rheumatoid arthritis.

Recent studies have found different risk factors of fragility fractures which are not currently recognised in FRAX™ tool. This observational study aims to evaluate parameters strongly associated with fracture risk in coeliac patients.

Methods: Data was collected from patients with coeliac disease who were referred for dual-energy X-ray absorptiometry (DEXA) scans in the North West of England between 2004 and 2019. Variables include patient demographics, FRAX™ risk factors, L1-L4 BMD, fat percentages of the whole body, abdomen and both femurs. Data analysis was conducted using a chi-square test for categorical variables, and student t-test for continuous variables. Subsequently, univariate and multivariate logistic regression analyses were performed to identify parameters independently associated with outcomes of fracture. Baseline characteristics included are tabulated by fracture status as shown in Table 1.

Results: A total of 1220 patients were analysed. Mean age at DEXA scan was 63.9 years (SD 14.1). 285 (23.4%) patients sustained a fracture, among which 239 (83.9%) patients were females. Patients with a fracture had a significantly lower BMD at both the femoral necks, across the entire femur, and the lumbar spine (all p< 0.001), as well as a higher fat percentage in both femurs (p< 0.001), abdomen (p=0.027), and total body fat percentage (p=0.017). Fractures were also significantly associated with steroid use (p=0.026), rheumatoid arthritis (p=0.009), and family history of fracture (p=0.047).

Our univariate regression model established that a lower BMD and higher fat percentage at all measured sites were significantly associated with an increased risk of fractures. The results can be seen in Table 2.
The multivariate model, adjusted for other covariates, revealed that lumbar spine BMD, abdominal fat percentage, total fat percentage, left femoral fat percentage, and positive family history were strong predictors of fracture in this group of patients. This is shown in Table 3.

Conclusion: Our study concluded that lower lumbar spine BMD is significantly associated with increased prevalence of fractures, a relationship that has not been widely recognised in larger cohort studies. In addition, abdominal fat percentage, total fat percentage, and left femoral fat percentage were found to be significant factors predisposing to increased fracture in coeliac patients. This implies the need to re-evaluate the clinical utility of fracture risk assessment tools like FRAX™ and consider incorporating additional parameters to improve fracture risk stratification in coeliac patients.