<p><strong>BACKGROUND &amp; AIMS: </strong>Celiac disease can reduce bone mineral density. We sought to determine the prevalence and risk factors for low areal bone mineral density (aBMD) in children with celiac disease.</p>

<p><strong>METHODS: </strong>We performed a retrospective cohort study of 673 children with celiac disease (63% female; median age at diagnosis, 10.6 y; interquartile range, 7.8-13.9) who underwent dual x-ray absorptiometry (DXA) from 2009 through 2016 at the Children's Hospital of Philadelphia. We collected demographic, clinical, and laboratory data from medical records. We performed logistic regression analysis to identify factors associated with low (Z less than -2) lumbar spine aBMD Z (aBMD-Z) scores at initial and subsequent tests.</p>

<p><strong>RESULTS: </strong>The time between diagnosis of celiac disease and first DXA was 0 days (interquartile range, -11 to 31 d). The mean aBMD-Z score at the children's initial scan was -0.4 ± 1.2; 46 children had aBMD-Z scores less than -2 (6.8%; 95% CI, 5.2%-9.0%). Those who had a second DXA analysis (n&nbsp;= 108; 16.0%) had a significant increase in aBMD-Z score (mean change, 0.29; P&nbsp;= .0005). Higher body mass index (BMI) was associated with lower odds of a low aBMD-Z score at the initial DXA analysis (odds ratio, 0.46, 95% CI, 0.35-0.50). BMI-Z scores greater than -0.4 identified children with a low aBMD-Z at their initial DXA analysis with a 95% negative predictive value.</p>

<p><strong>CONCLUSIONS: </strong>Approximately 7% of subjects with celiac disease had a low aBMD-Z score, determined by DXA, at the time of diagnosis; this value was nearly 3-fold higher than expected from a population of children of this age and sex distribution. BMI-Z scores could be used to identify children with celiac disease at risk for low BMD who should receive DXA screening.</p>

<p><strong>OBJECTIVE: </strong>To determine the incidence of and risk factors for development of celiac disese (CD) in individuals with type 1 diabetes.</p>

<p><strong>METHODS: </strong>Cohort study using The Health Improvement Network (THIN), a United Kingdom primary care database of &gt;13 million people. Individuals with incident type 1 diabetes diagnosed at 1-35 years of age between 1995 and 2015 with no previous diagnosis of CD were included. Cox regression was used to identify risk factors for CD, including age at diabetes diagnosis and sex, while adjusting for year of diagnosis to control for potential rising incidence in CD over time.</p>

<p><strong>RESULTS: </strong>Subjects (n=9,180; 43% female) had a median observation time of 5.1 years (IQR 2.0-10.1). CD was diagnosed in 196 (2%) during follow up. Median time to diagnosis was 2.1 years, but 25% were diagnosed more than 5 years after diabetes diagnosis. Incidence (per 10,000 person-years) was greater in females (43.0 [95%CI 35.2-52.0]) vs males (26.8 [95%CI 21.5-32.9]). In multivariable Cox regression stratified by childhood- versus young adult-onset diabetes, younger age at diabetes diagnosis within childhood (HR 0.91 [95% CI 0.88-0.94]) and female sex among the adult-onset diabetes group (HR 3.19 [95% CI 1.39-7.34]) were associated with greater risk of CD.</p>

<p><strong>CONCLUSIONS: </strong>As expected, incidence of CD was higher in individuals with childhood-onset diabetes versus those with adult-onset diabetes. However, individuals with diabetes are at risk of developing CD throughout childhood and adulthood, and prolonged screening after diagnosis may be warranted. Prospective studies are needed in order to guide risk-stratified approaches to screening. This article is protected by copyright. All rights reserved.</p>