Celiac Disease Does Not Influence Fracture Risk in Young Patients with Type 1 Diabetes

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• 作者：Norelle R. Reilly ; MD¹ ; ² ; Benjamin Lebwohl ; MD ; MS² ; ³ ; Kaziwe Mollazadegan ; MD ; PhD³ ; Karl Michaë ; lsson ; MD ; PhD⁴ ; Peter H.R. Green ; MD² ; Jonas F. Ludvigsson ; MD ; PhD³ ; ⁵ ; ^{jonasludvigsson@yahoo.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：BMD ; Bone mineral density ; CD ; Celiac disease ; GFD ; Gluten-free diet ; HR ; Hazard ratio ; ICD ; International Classification of Diseases ; T1D ; Type 1 diabetes
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：169
• 期：Complete
• 页码：49-54
• 全文大小：244 K

文摘

To examine the risk of any fractures in patients with both type 1 diabetes (T1D) and celiac disease (CD) vs patients with T1D only.

Study design

We performed a population-based cohort study. We defined T1D as individuals aged ≤30 years who had a diagnosis of diabetes recorded in the Swedish National Patient Register between 1964 and 2009. Individuals with CD were identified through biopsy report data between 1969 and 2008 from any of Sweden's 28 pathology departments. Some 958 individuals had both T1D and CD and were matched for sex, age, and calendar period with 4598 reference individuals with T1D only. We then used a stratified Cox regression analysis, where CD was modeled as a time-dependent covariate, to estimate the risk of any fractures and osteoporotic fractures (hip, distal forearm, thoracic and lumbar spine, and proximal humerus) in patients with both T1D and CD compared with that in patients with T1D only.

Results

During follow-up, 12 patients with T1D and CD had a fracture (1 osteoporotic fracture). CD did not influence the risk of any fracture (adjusted hazard ratio = 0.77; 95% CI = 0.42-1.41) or osteoporotic fractures (adjusted hazard ratio = 0.46; 95% CI = 0.06-3.51) in patients with T1D. Stratification for time since CD diagnosis did not affect risk estimates.

Conclusion

Having a diagnosis of CD does not seem to influence fracture risk in young patients with T1D. Follow-up in this study was, however, too short to ascertain osteoporotic fractures which traditionally occur in old age.