P2637 - Personalized Medicine for Bone Disease in Celiac Disease: Do All Patients Need a Bone Density Scan?

Arjun Chatterjee, MD¹, Baila Elkin, MD¹, Andrew Ford, MD², Claire Jansson-Knodell, MD², Alberto Rubio-Tapia, MD^1
1Cleveland Clinic Foundation, Cleveland, OH; ²Cleveland Clinic, Cleveland, OH

Introduction: Celiac disease (CD) is associated with bone disease, including osteopenia, osteoporosis, and increased fracture risk. Current adult guidelines recommend global screening for bone disease with a dual-energy X-ray absorptiometry (DXA) after CD diagnosis. However, in times of personalized medicine, a DXA may be more beneficial in patients at the highest risk for bone disease, and DXA might not be necessary for those at the lowest risk. Our hypothesis is that a more precise utilization of DXA screening is possible based on the stratification of bone disease risk at the time of CD diagnosis.

Aims: We investigated the (1) frequency of bone disease based on DXA screening and (2) factors associated with bone disease following CD diagnosis.

Methods: We queried the electronic medical record at our institution to identify adults (age ≥18 years old) with biopsy-proven celiac disease who had a DXA following CD diagnosis. Patients with DXA prior to CD diagnosis, missing biopsy reports, or ambiguous CD diagnosis timelines were excluded. Bone disease was defined as a DXA result with either osteoporosis or osteopenia according International Osteoporosis Foundation. Descriptive statistics were used to summarize the data. Using multivariate logistic regression, the hazard ratios (HR) and 95% confidence intervals (CI) for the risk factors for bone disease were determined.

Results: We included 214 patients (median age 45 years, 72% women). There were 97 patients (45%) with a normal DXA and 117 patients (55%) with bone disease (87 had osteopenia, and 30 had osteoporosis).

Univariate analysis revealed that CD patients with bone disease were more likely to be older, male, have a lower body mass index (BMI), and smokers. Classical presentation was not associated with bone disease. Table 1

The multivariate analysis demonstrated that age (HR: 1.07, CI: 1.04-1.1, P=0.001) and male gender (HR: 2.5, CI: 1.2-5.4, P=0.02) conveyed a higher risk of having bone disease, while BMI was protective (HR: 0.91, CI: 0.86-0.96, P=0.001). Table 2

Any incident fracture after DXA was documented in 3 (3%) of 97 patients with normal DXA and 12 (10%) of 117 patients with bone disease. (P < 0.05)

Discussion: Following diagnosis, more than half of CD patients had bone disease by DXA. Risk factors for bone disease include being male, older age, and lower BMI. Evaluation of risk factors for bone disease at diagnosis may improve utilization of DXA screening in patients with CD.



Disclosures:


Arjun Chatterjee, MD¹, Baila Elkin, MD¹, Andrew Ford, MD², Claire Jansson-Knodell, MD², Alberto Rubio-Tapia, MD¹. P2637 - Personalized Medicine for Bone Disease in Celiac Disease: Do All Patients Need a Bone Density Scan?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.