Small Bowel Section, Department of Medicine, "Dr. C. Bonorino Udaondo" Gastroenterology Hospital, 1264 Buenos Aires, Argentina.
World J Gastroenterol. 2011 Jul 7;17(25):3035-42. doi: 10.3748/wjg.v17.i25.3035.
To determine the incidence of peripheral fractures in patients with celiac disease (CD) and the effect of treatment on fracture risk.
We compared the incidence and risk of peripheral fractures before and after diagnosis between a cohort of 265 patients who had been diagnosed with CD at least 5 years before study entry and a cohort of 530 age- and sex-matched controls who had been diagnosed with functional gastrointestinal disorders. Data were collected through in-person interviews with an investigator. The overall assessment window for patients was 9843 patient-years (2815 patient-years after diagnosis).
Compared with the control group, the CD cohort showed significantly higher incidence rate and risk of first peripheral fracture before diagnosis [adjusted hazard ratio (HR): 1.78, 95% CI: 1.23-2.56, P < 0.002] and in men (HR: 2.67, 95% CI: 1.37-5.22, P < 0.004). Fracture risk was significantly associated with the classic CD presentation with gastrointestinal symptoms (P < 0.003). In the time period after diagnosis, the risk of fractures was comparable between the CD cohort and controls in both sexes (HR: 1.08, 95% CI: 0.55-2.10 for women; HR: 1.57, 95% CI: 0.57-4.26 for men).
CD patients have higher prevalence of fractures in the peripheral skeleton before diagnosis. This is associated with male sex and classic clinical presentation. The fracture risk was reduced after the treatment.
确定腹腔疾病(CD)患者外周骨折的发生率以及治疗对外周骨折风险的影响。
我们比较了至少在研究入组前 5 年被诊断为 CD 的 265 例患者队列与被诊断为功能性胃肠疾病的 530 例年龄和性别匹配对照队列的骨折发生率和风险。通过与调查员进行面对面访谈收集数据。患者的总体评估窗口为 9843 患者年(诊断后 2815 患者年)。
与对照组相比,CD 队列在诊断前的首次外周骨折的发生率和风险明显更高[校正后的危险比(HR):1.78,95%可信区间(CI):1.23-2.56,P < 0.002],且男性患者更高(HR:2.67,95% CI:1.37-5.22,P < 0.004)。骨折风险与具有胃肠道症状的经典 CD 表现显著相关(P < 0.003)。在诊断后的时间段内,男女患者 CD 队列和对照组的骨折风险无显著差异(女性 HR:1.08,95% CI:0.55-2.10;男性 HR:1.57,95% CI:0.57-4.26)。
CD 患者在诊断前外周骨骼的骨折发生率更高。这与男性性别和经典临床表现有关。治疗后骨折风险降低。