Bone Abstracts

Coeliac disease is associated with reduced bone mineral density (BMD) due to nutrient malabsorption and chronic inflammation. NICE guidance recommends fracture-risk assessment and consideration of dual-energy X-ray absorptiometry (DEXA) in adults with coeliac disease who have relevant clinical risk factors. This audit evaluated compliance with NICE guidance within a specialist coeliac service and explored predictors of abnormal BMD, as undetected low BMD may increase fracture risk and delay appropriate intervention. A retrospective audit was conducted in 158 adults attending a coeliac clinic in a London Teaching Hospital. Demographic and clinical variables relevant to fracture-risk assessment were extracted from electronic records, including age, sex, BMI, vitamin D status (25-hydroxyvitamin D categorised as low vs normal), fragility fracture history, glucocorticoid use, smoking or alcohol risk, menopausal status, and QFracture score. Eligibility for DEXA scanning was determined according to NICE CG146. Compliance was defined as DEXA performed or a documented clinical justification when indicated. Associations between clinical factors and abnormal BMD were assessed using chi-squared and Wilcoxon tests, with multivariable logistic regression to identify independent predictors. Of 158 patients, 135 (85.4%) met NICE criteria for fracture-risk assessment and potential DEXA referral. Compliance was high, with 134/135 (99.3%) having DEXA completed or a documented justification. Abnormal BMD was identified in 61% of scanned patients, including 43 with osteopenia and 15 with osteoporosis, indicating a substantial burden of bone disease in this specialist coeliac population. Age ≥50 years was strongly associated with abnormal BMD (P 0.000001), and lower BMI was also significant (P 0.016). Vitamin D deficiency showed a borderline association (P 0.05), while gluten-free diet adherence was not significantly associated with BMD outcomes. Although QFracture scores correlated with BMD status (P 0.001), several patients with abnormal DEXA were classified as low fracture risk. Compliance with NICE DEXA guidance in this coeliac service was high. However, abnormal BMD was common, particularly in older patients and those with lower BMI. The presence of abnormal DEXA findings in some patients classified as low fracture risk suggests that current assessment tools may underestimate bone disease in coeliac disease. Clinicians should maintain a low threshold for DEXA assessment.