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Chronic villous atrophy increased hip fracture risk in celiac disease
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Patients with celiac disease and chronic villous atrophy have an increased risk for hip fracture compared with those who had mucosal healing, according to data published in the Journal of Clinical Endocrinology and Metabolism.
“We believe that giving the mucous membrane … a chance to heal can lower the risk of complications, including bone fractures, in celiac patients,” Jonas F. Ludvigsson, PhD, MD, of Karolinska University Hospital and Karolinska Institute in Stockholm, said in a press release. “Our research confirmed that patients had a higher rate of hip fractures when tissue damage persisted over time. Sticking to a gluten-free diet is crucial for minimizing tissue damage and reducing the risk of a serious fracture that could cause other complications.”
The main fracture outcomes included: any fracture; classical osteoporotic fractures, consisting of fractures of the distal forearm, clinical vertebral fractures of the thoracic and lumbar spine, and proximal humerus; and hip fracture.
Benjamin Lebwohl
Of 29,096 patients with celiac disease, 7,146 (26%) underwent a follow-up biopsy between 6 months and 5 years after their initial diagnosis, and 3,105 (43%) had persistent villous atrophy.
There was no significant association between persistent villous atrophy and overall fractures (HR=0.93; 95% CI, 0.82-10.6) vs. those with mucosal healing; or with likely osteoporotic fractures (HR=1.11; 95% CI, 0.84-1.46).
“Physicians have debated whether people with celiac disease actually benefit from a follow-up biopsy to determine the level of tissue healing taking place,” Benjamin Lebwohl, MD, MS, of the Celiac Disease Center at Columbia University Medical Center in New York, said in a press release. “These findings suggest that a follow-up biopsy can be useful for predicting complications down the road.”
This association was most significant for fractures of the distal forearm (HR=1.19; 95% CI, 0.84-1.69), researchers wrote. However, persistent villous atrophy was associated with an increased risk for hip fracture (HR=1.67; 95% CI, 1.05-2.66).
The researchers also observed a heterogeneous risk for hip fracture 5 years after the follow-up biopsy (HR=2.18; 95% CI, 1.17-4.05). When they considered patients who had varying degrees of villous atrophy, those with subtotal or total villous atrophy had a greater risk for hip fracture (HR=2.16; 95% CI, 1.06-4.41) compared with those with partial villous atrophy (HR=1.7; 95% CI, 0.82-3.49), according to data.
These data demonstrate that persistent villous atrophy evident at follow-up biopsy may be a predictor of hip fracture risk in patients with celiac disease.
Disclosure: The researchers report no relevant financial disclosures.
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