October 05, 2017
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Fracture risk increases with type 1 diabetes, celiac disease

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Eleanor Thong
Eleanor P. Thong

Young adults with type 1 diabetes and celiac disease are more likely to sustain fractures than those who have type 1 diabetes alone, according to findings reported in Clinical Endocrinology.

Type 1 diabetes is associated with impaired bone quality and increased fracture rates, whereas celiac disease is also a recognized factor for secondary osteoporosis and fracture, leading researchers to speculate that the risk may be additive for patients with both conditions, Eleanor P. Thong, MBBS, FRACP, an endocrinology fellow at Monash Health in Clayton, Australia, and colleagues wrote in the study background.

In a retrospective, cross-sectional study, Thong and colleagues analyzed medical records from 346 patients with type 1 diabetes alone (median age, 23 years) and 49 patients with type 1 diabetes and celiac disease (median age, 24 years) attending specialist diabetes outpatient clinics between August 2016 and February 2017 at Monash Health. Patients with comorbid chronic kidney disease, glucocorticoid use, hypogonadism and untreated hyperthyroidism were excluded. Researchers assessed previous fractures (verified by radiologic reports and medical records), duration of type 1 diabetes, glycemic control, hypoglycemia incidence (assessed via glucose monitoring devices or logbooks), daily insulin dose, microvascular complications and celiac disease status.

Researchers documented 21 fractures in 18 patients in the cohort. Overall, a higher proportion of patients had fractures in the type 1 diabetes/celiac disease group vs. the type 1 diabetes only group (12.2% vs. 3.5%; P = .02). However, there was no difference in minimal trauma fractures between the two groups (33.3% vs. 25%). After adjusting for age, sex, BMI, vitamin D status, hypoglycemia, microvascular complications and HbA1c, researchers observed a relationship between celiac disease and fracture (OR = 3.5; 95% CI, 1.01-12.12).

Only three patients (6.1%) had a documented evaluation of bone mineral density within the past 5 years, according to researchers.

Patients with type 1 diabetes and celiac disease also had a higher prevalence of frequent hypoglycemia, defined as at least two episodes per week, compared with those who had type 1 diabetes alone (55.1% vs. 37.7%; P < .001). After adjustment for age, sex, duration of diabetes, HbA1c, BMI and total daily dose of insulin, the relationship between celiac disease and hypoglycemia remained significant (OR = 3.28; 95% CI, 1.61-6.69); however, the higher incidence of hypoglycemia was not independently associated with fractures, according to researchers.

“Clinicians should actively screen for and manage hypoglycemia in patients with concomitant type 1 diabetes and celiac disease, as hypoglycemia is a risk factor for falls, seizures and, ultimately, fractures,” Thong told Endocrine Today. “Prospective studies examining the long-term impacts of celiac disease on bone health and on glycemic control in type 1 diabetes are needed, particularly in older adults where the absolute risk of fracture is higher.” by Regina Schaffer

For more information:

Eleanor P. Thong, MBBS, FRACP, can be reached at Monash Medical Center, 246 Clayton Road, Clayton, Victoria, Australia, 3168; email: eleanor.thong@monash.edu.

Disclosures: The authors report no relevant financial disclosures.