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Celiac disease: A missed cause of metabolic bone disease.

Rastogi A, Bhadada SK, Bhansali A, Kochhar R, Santosh R - Indian J Endocrinol Metab (2012)

Bottom Line: Four of the five patients had additional risk factors such as antiepileptic drugs, chronic alcohol consumption, malnutrition, and associated vitamin D deficiency which might have contributed to the severity of MBD.Patients show significant improvement in clinical, biochemical, and radiological parameters with gluten-free diet, calcium, and vitamin D supplementation.CD should be looked for routinely in patients presenting with unexplained MBD.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, PGIMER, Chandigarh, India.

ABSTRACT

Introduction: Celiac disease (CD) is a highly prevalent autoimmune disease. The symptoms of CD are varied and atypical, with many patients having no gastrointestinal symptoms. Metabolic bone disease (MBD) is a less recognized manifestation of CD associated with spectrum of musculoskeletal signs and symptoms, viz. bone pains, proximal muscle weakness, osteopenia, osteoporosis, and fracture. We here report five patients who presented with severe MBD as the only manifestation of CD.

Materials and methods: Records of 825 patients of CD diagnosed during 2002-2010 were retrospectively analyzed for clinical features, risk factors, signs, biochemical, and radiological parameters.

Results: We were able to identify five patients (0.6%) of CD who had monosymptomatic presentation with musculoskeletal symptoms and signs in the form of bone pains, proximal myopathy, and fragility fractures without any gastrointestinal manifestation. All the five patients had severe MBD in the form of osteopenia, osteoporosis, and fragility fractures. Four of the five patients had additional risk factors such as antiepileptic drugs, chronic alcohol consumption, malnutrition, and associated vitamin D deficiency which might have contributed to the severity of MBD.

Conclusion: Severe metabolic disease as the only presentation of CD is rare. Patients show significant improvement in clinical, biochemical, and radiological parameters with gluten-free diet, calcium, and vitamin D supplementation. CD should be looked for routinely in patients presenting with unexplained MBD.

No MeSH data available.


Related in: MedlinePlus

X-ray legs showing healing looser's zone and fractures (arrows)
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Figure 3: X-ray legs showing healing looser's zone and fractures (arrows)

Mentions: On examination, she was bed bound, appeared thin, frail, and had generalized bony tenderness. She had kyphosis and shrunken pelvis. The right upper limb was immobilized in a plaster cast and there was limitation of movements of left elbow and wrist. She had generalized atrophy of muscles with decrease in muscle strength (power was 3/5). Skeletal survey showed generalized severe osteopenia with tufting of phalanges. She had fracture of multiple ribs [Figure 1], wedge collapse of upper and lower thoracic vertebrae, triradiate pelvis with coxa-vara and protrusio acetabuli [Figure 2], fracture of inferior ramii of pelvis, right humerus, and upper end of left ulna. Her 99mTc methylene-diphosphonate (MDP) bone scan showed generalized increase in metabolic activity over the skeleton. Dual energy X-ray absorptiometry (DEXA) showed T-score of -4.9 at neck of femur and -7.1 at lumbar spine (L1-L4). She gradually improved and during follow-up of 1 year with the CD treatment protocol, her fractures had healed [Figure 3], and she was able to stand with support. Subsequently, at the end of 3 years of follow-up, she is performing her all house hold work.


Celiac disease: A missed cause of metabolic bone disease.

Rastogi A, Bhadada SK, Bhansali A, Kochhar R, Santosh R - Indian J Endocrinol Metab (2012)

X-ray legs showing healing looser's zone and fractures (arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475904&req=5

Figure 3: X-ray legs showing healing looser's zone and fractures (arrows)
Mentions: On examination, she was bed bound, appeared thin, frail, and had generalized bony tenderness. She had kyphosis and shrunken pelvis. The right upper limb was immobilized in a plaster cast and there was limitation of movements of left elbow and wrist. She had generalized atrophy of muscles with decrease in muscle strength (power was 3/5). Skeletal survey showed generalized severe osteopenia with tufting of phalanges. She had fracture of multiple ribs [Figure 1], wedge collapse of upper and lower thoracic vertebrae, triradiate pelvis with coxa-vara and protrusio acetabuli [Figure 2], fracture of inferior ramii of pelvis, right humerus, and upper end of left ulna. Her 99mTc methylene-diphosphonate (MDP) bone scan showed generalized increase in metabolic activity over the skeleton. Dual energy X-ray absorptiometry (DEXA) showed T-score of -4.9 at neck of femur and -7.1 at lumbar spine (L1-L4). She gradually improved and during follow-up of 1 year with the CD treatment protocol, her fractures had healed [Figure 3], and she was able to stand with support. Subsequently, at the end of 3 years of follow-up, she is performing her all house hold work.

Bottom Line: Four of the five patients had additional risk factors such as antiepileptic drugs, chronic alcohol consumption, malnutrition, and associated vitamin D deficiency which might have contributed to the severity of MBD.Patients show significant improvement in clinical, biochemical, and radiological parameters with gluten-free diet, calcium, and vitamin D supplementation.CD should be looked for routinely in patients presenting with unexplained MBD.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, PGIMER, Chandigarh, India.

ABSTRACT

Introduction: Celiac disease (CD) is a highly prevalent autoimmune disease. The symptoms of CD are varied and atypical, with many patients having no gastrointestinal symptoms. Metabolic bone disease (MBD) is a less recognized manifestation of CD associated with spectrum of musculoskeletal signs and symptoms, viz. bone pains, proximal muscle weakness, osteopenia, osteoporosis, and fracture. We here report five patients who presented with severe MBD as the only manifestation of CD.

Materials and methods: Records of 825 patients of CD diagnosed during 2002-2010 were retrospectively analyzed for clinical features, risk factors, signs, biochemical, and radiological parameters.

Results: We were able to identify five patients (0.6%) of CD who had monosymptomatic presentation with musculoskeletal symptoms and signs in the form of bone pains, proximal myopathy, and fragility fractures without any gastrointestinal manifestation. All the five patients had severe MBD in the form of osteopenia, osteoporosis, and fragility fractures. Four of the five patients had additional risk factors such as antiepileptic drugs, chronic alcohol consumption, malnutrition, and associated vitamin D deficiency which might have contributed to the severity of MBD.

Conclusion: Severe metabolic disease as the only presentation of CD is rare. Patients show significant improvement in clinical, biochemical, and radiological parameters with gluten-free diet, calcium, and vitamin D supplementation. CD should be looked for routinely in patients presenting with unexplained MBD.

No MeSH data available.


Related in: MedlinePlus