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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 pelvis showing right hip prosthesis after replacement
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Figure 4: X-ray pelvis showing right hip prosthesis after replacement

Mentions: On examination, he had kyphosis, loss of chest volume, and pectus carinatum. He had limitation of movement of the right hip joint and tenderness over all muscle groups. Skeletal survey showed diffuse rarefaction of the bones, looser zone in pubic ramii and scapula, fractures over multiple ribs, neck of left humerus, and neck of the right femur. DEXA scan of the lumbar spine showed T-score of -1.8 with increased osteoblastic activity at multiple sites on 99mTc MDP bone scan. He had remarkable relief in bone pains with CD treatment during follow-up of six months. The fracture site showed a good callous response except for right hip joint, for which he underwent total hip replacement [Figure 4].


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 pelvis showing right hip prosthesis after replacement
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: X-ray pelvis showing right hip prosthesis after replacement
Mentions: On examination, he had kyphosis, loss of chest volume, and pectus carinatum. He had limitation of movement of the right hip joint and tenderness over all muscle groups. Skeletal survey showed diffuse rarefaction of the bones, looser zone in pubic ramii and scapula, fractures over multiple ribs, neck of left humerus, and neck of the right femur. DEXA scan of the lumbar spine showed T-score of -1.8 with increased osteoblastic activity at multiple sites on 99mTc MDP bone scan. He had remarkable relief in bone pains with CD treatment during follow-up of six months. The fracture site showed a good callous response except for right hip joint, for which he underwent total hip replacement [Figure 4].

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