The Prevalence of Celiac Disease in a Fracture Liaison Service Population

Celiac disease (CD) is a known risk factor for osteoporosis and fractures. The prevalence of CD in patients with a recent fracture is unknown. We therefore systematically screened patients at a fracture liaison service (FLS) to study the prevalence of CD. Patients with a recent fracture aged >= 50 years were invited to VieCuri Medical Center's FLS. In FLS attendees, bone mineral density (BMD) and laboratory evaluation for metabolic bone disorders and serological screening for CD was systematically evaluated. If serologic testing for CD was positive, duodenal biopsies were performed to confirm the diagnosis CD. Data were collected in 1042 consecutive FLS attendees. Median age was 66 years (Interquartile range (IQR) 15), 27.6% had a major and 6.9% a hip fracture, 26.4% had osteoporosis and 50.8% osteopenia. Prevalent vertebral fractures were found in 29.1%. CD was already diagnosed in two patients (0.19%), one still had a positive serology. Three other patients (0.29%) had a positive serology for CD (one with gastro-intestinal complaints). In two of them, CD was confirmed by duodenal histology (0.19%) and one refused further evaluation. The prevalence of biopsy-proven CD was therefore 0.38% (4/1042) of which 0.19% (2/1042) was newly diagnosed. The prevalence of CD in patients with a recent fracture at the FLS was 0.38% and within the range of reported prevalences in the Western-European population (0.33-1.5%). Newly diagnosed CD was only found in 0.19%. Therefore, standard screening for CD in FLS patients is not recommended

Pulsotypes and STs of multi drug resistant and/or ESBL producing isolates.

<p>ESBL singletons: ESBL strains with a pulsotype of which no similar type has been demonstrated among the other typed isolates.</p><p>ST  =  sequence type, CC  =  clonal complex, n  =  amount.</p

Antimicrobial resistance among (%) <i>E. coli</i> isolates.

<p>NL  =  the Netherlands, B  =  Belgium and G  =  Germany, -  =  not significant.</p

Number and identification of ESBL producing isolates.

*<p>Significantly higher than among isolates from the Netherlands (p<0.05).</p

Antibiotic resistance and suitability of antibiotics for empiric treatment.

<p>Antibiotic resistance for the different antibiotics among the three groups of isolates compared with a 10% resistance cutoff to decide whether an antibiotic agent is suitable for empiric treatment. AMC  =  amoxicillin-clavulanic acid, TZP  =  piperacillin-tazobactam, CXM  =  cefuroxime, CAZ  =  ceftazidime, FIX  =  cefixime, TIB  =  ceftibuten, CIP  =  ciprofloxacin, NIT  =  nitrofurantoin, SXT  =  trimethoprim-sulfamethoxazole and GEN  =  gentamicin.</p