A serological diagnosis of coeliac disease is associated with osteoporosis in older Australian adults

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Potter, MDE 
Walker, MM 
Hancock, S 
Holliday, E 
Brogan, G 

Previously thought to be mainly a disorder of childhood and early adult life, coeliac disease (CeD) is increasingly diagnosed in older adults. This may be important given the association between CeD and osteoporosis. The primary aim of this study was to determine the seroprevalence of undiagnosed CeD (‘at-risk serology’) in an older Australian community and relate this to a diagnosis of osteoporosis and fractures during a follow-up period of 12 years. We included participants from the Hunter Community Study (2004–2007) aged 55–85, who had anti-tissue transglutaminase (tTG) titres, human leukocyte antigen (HLA) genotypes, and bone mineral density measurements at baseline. Follow-up data included subsequent diagnosis of CeD and fractures using hospital information. ‘At-risk’ serology was defined as both tTG and HLA positivity. Complete results were obtained from 2122 patients. The prevalence of ‘at-risk’ serology was 5%. At baseline, 3.4% fulfilled criteria for a diagnosis of osteoporosis. During a mean of 9.7 years of follow-up, 7.4% of the cohort suffered at least one fracture and 0.7% were subsequently diagnosed with CeD. At-risk serology was significantly associated with osteoporosis in a multivariate model (odds ratio 2.83, 95% confidence interval 1.29–6.22); there was insufficient power to look at the outcome of fractures. The results of this study demonstrate that at-risk CeD serology was significantly associated with concurrent osteoporosis but not future fractures. Most individuals with a serological diagnosis of CeD were not diagnosed with CeD during the follow-up period according to medical records. Coeliac disease likely remains under-diagnosed.

coeliac disease, fractures, osteoporosis, Age Factors, Aged, Aged, 80 and over, Autoantibodies, Bone Density, Celiac Disease, Female, GTP-Binding Proteins, HLA Antigens, Humans, Male, Middle Aged, New South Wales, Osteoporosis, Osteoporotic Fractures, Prevalence, Protein Glutamine gamma Glutamyltransferase 2, Risk Factors, Seroepidemiologic Studies, Serologic Tests, Time Factors, Transglutaminases
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The study was funded by the University of Newcastle, the Hunter Medical Research Institute, and the Vincent Fairfax Family Foundation