Fracture risk among children and adolescents with celiac disease: a nationwide cohort study

Background: Metabolic bone disease is a common manifestation of celiac disease (CD). We aimed to assess fracture risk among children and adolescents with CD compared with a matched group. Methods: This registry-based cohort study included 2372 children with CD who were matched 1:5 to 11,860 children without CD. Demographic and clinical data were obtained from the electronic database of Meuhedet, a health maintenance organization. Fracture events at ages 1–18 years were identified by coded diagnoses. Results: The overall fracture incidence rate was 256 per 10,000 patient-years (PY) in the CD group and 165 per 10,000 PY in the comparison group (p < 0.001). The hazard ratio (HR) to have a fracture was 1.57 (95% CI 1.43–1.73, p < 0.001) for the CD group compared to the matched group. The HR for multiple fractures was 1.67 (95% CI 1.38–2.01, p < 0.001). Analysis of the pre- and post-diagnosis periods separately showed that the HR for fractures in the pre-diagnosis period was 1.64 (95% CI 1.42–1.88, p < 0.001) for the CD group compared to the matched group, and 1.52 (95% CI 1.26–1.71, p < 0.001) in the period from diagnosis to the end of the follow-up period. Conclusions: Children with CD had increased fracture risk both preceding and following the diagnosis of CD. Impact: One manifestation of celiac disease (CD) is metabolic bone disease, including osteoporosis and impaired bone mineralization.We found increased fracture risk among children with CD, both preceding the CD diagnosis and during the years following the diagnosis.Recognition of the high risk of fractures in this population may help promote prevention.Further studies are needed to evaluate changes in bone quantity and quality after initiation of a gluten-free diet, and to identify those at risk for persistent metabolic bone disease.