[Causes of osteoporosis: don't forget celiac disease]

A 60-year old woman presented with osteoporosis. Because clinical symptoms did not improve after treatment, further diagnostic procedures were performed in order to further characterize the metabolic bone disease. The patient reported loss of weight,nonspecific gastrointestinal symptoms (recurrent abdominal pain),and constipation. The diet history revealed a milk intolerance. Several family members were suffering from autoimmune diseases. During physical examination the patient exhibited clinical signs of osteoporosis(back pain, change of stature), but otherwise no pathological findings.

The technical examinations showed low bone mineral density at the spine. The routine laboratory examination (including serum calcium, phosphorus, alkaline phosphatase)was normal. However, further testing revealed low concentrations for 25-hydroxy-vitamin D, folic acid, vitamin B 12, an increased IgA and significantly elevated antigliadin antibodies and antiendomysial antibodies. Histopathological examination of the duodenal mucosa was in accordance with the diagnosis celiac sprue. The histopathologic examination of a transiliac bone biopsy exhibited high bone turnover, osteopenia, but no osteomalacia.

Therefore, the diagnosis of celiac sprue with metabolic bone disease was established. Treatment with gluten-free diet and supplementation of calcium and vitamin D was initiated.

This case demonstrates that careful diagnostic evaluation of patients with osteoporosis is necessary,because therapeutic consequences are the result.