P169 The clinical utility of FRAX in biopsy confirmed coeliac disease: the largest cohort study

Introduction

The role of routine dual-energy X-ray absorptiometry (DXA) scanning in the monitoring of bone health in coeliac disease (CD) patients is unclear. Current recommendations state that DXA scanning should be performed after 1 year in at-risk individuals, but there is limited data on methods to stratify fracture risk in patients with CD. We examined the clinical utility of the Fracture Risk Assessment tool (FRAX) in risk stratifying these patients. In the general population, the prevalence of osteoporosis at age 50 is 2%. We aimed to determine the prevalence of osteoporosis and risk factors for reduced bone mineral density (BMD) in patients with CD.

Methods

Data was collected on patients with CD who underwent DXA scanning between 2011 and 2022 to determine the prevalence of reduced BMD. DXA scanning produces a T score, a standardised measure of BMD. A normal score is greater than -1, osteopenia -1 to -2.4, and osteoporosis less than -2.5. The case notes of biopsy-confirmed CD patients (Marsh grade 2 or 3) diagnosed between 2001 and 2015 were also reviewed, allowing for a 7-year follow up, and information on their fracture outcomes and gluten exposure based on serological markers were collected. FRAX scores were analysed to assess their utility for predicting major osteoporotic fractures (MOF).

Results

Between 2011 and 2022, 1506 patients with CD had a DXA scan. Osteoporosis was more common in individuals with CD over the age of 50 compared with those under 50 (20.8% vs 8.7% respectively, p<0.001). On follow-up, 14.5% (88/605) of patients with biopsy-proven CD, diagnosed between 2001 and 2015, fractured a bone; 52.3% (46/88) were MOF, and 4.5% (4/88) were hip fractures. The FRAX tool without BMD had a sensitivity, specificity, PPV and NPV of predicting MOF of 23.3%, 85.2%, 16.3%, and 90% respectively, which was similar when BMD data from DXA scanning was included in the calculation. When adjusted for mean age and body mass index at DXA scan, the mean femoral neck T score was higher in those who did not have ongoing gluten exposure versus those who did (T score -0.492 vs -0.830 respectively, p=0.014).

Conclusions

Patients with CD have a higher prevalence of osteoporosis compared with the general population. Fractures are also common in CD patients and many of these are MOF. Patients who adhered to a gluten-free diet had a mean higher femoral neck BMD score. The FRAX tool can help with patient selection for DXA scanning by excluding those with low risk of fracture.