• Francesco Tovoli, Dante Pio Pallotta, Alice Giamperoli, Guido Zavatta, Kinga Skoracka, Alberto Raiteri, Chiara Faggiano, Iwona Krela-Kaźmierczak, and Alessandro Granito.
• Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. francesco.tovoli@unibo.it.
• Intern Emerg Med. 2023 Aug 1; 18 (5): 140514141405-1414.

BackgroundMetabolic bone disease is frequently found in patients with coeliac disease (CD). Despite its high prevalence, international guidelines are partially discordant about its management due to the lack of long-term data.MethodsWe retrospectively evaluated a large dataset of prospectively collected data of CD patients assessing the variation of DXA parameters and estimated fracture risk according to the FRAX® score in a 10-year follow-up. Incident fractures are reported, and the predictive ability of the FRAX® score is verified.ResultsWe identified 107 patients with low bone density (BMD) at the diagnosis of CD and a 10-year follow-up. After improving at the first follow-up, T-scores slowly reduced over time but with no clinically relevant differences between the first and last examination (lumbar spine: from - 2.07 to - 2.07, p = 1.000; femoral neck: from - 1.37 to - 1.55, p = 0.006). Patients with osteoporosis at the index measurement had more marked fluctuations than those with osteopenia; the latter group also showed minimal modifications of the FRAX® score over time. Six incident major fragility fractures occurred, with a good predictive ability of the FRAX® (AUC 0.826).ConclusionAdult CD patients with osteopenia and no risk factors had substantially stable DXA parameters and fracture risk during a 10-year follow-up. A dilated interval between follow-up DXA for these patients could be considered to reduce diagnosis-related time and costs, maintaining a 2-year interval for patients with osteoporosis or risk factors.© 2023. The Author(s).

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