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[Ten fractures in 21 years]
J Fritzsch1, G Hennicke, A Tannapfel
1Abteilung für Innere Medizin, HELIOS-Klinik Zwenkau. jfritzsch@zwenkau.helios-kliniken.de
Der Unfallchirurg
|June 1, 2005
Summary
This case study highlights how undiagnosed celiac disease can lead to osteomalacia and multiple fractures. Early detection and a gluten-free diet are crucial for managing this metabolic bone disease.
Area of Science:
- Internal Medicine
- Gastroenterology
- Endocrinology
Background:
- Osteomalacia, a condition characterized by softening of the bones, can result from various underlying causes, including malabsorption syndromes.
- Celiac disease, an autoimmune disorder triggered by gluten ingestion, can present with subtle gastrointestinal symptoms or even oligosymptomatically, leading to delayed diagnosis.
Observation:
- A 78-year-old female experienced ten spontaneous bone fractures over 21 years, progressively becoming wheelchair-bound.
- Initial investigations did not reveal the underlying cause, underscoring the challenge of diagnosing oligosymptomatic conditions.
Findings:
- The patient was diagnosed with osteomalacia secondary to oligosymptomatic celiac disease with associated malabsorption.
- Elevated alkaline phosphatase levels were a key indicator differentiating osteomalacia from osteoporosis.
Implications:
- This case emphasizes the importance of a thorough metabolic bone disease workup in patients with recurrent spontaneous fractures.
- Early diagnosis of celiac disease and initiation of a gluten-free diet, alongside calcium and vitamin D supplementation, are vital for bone health normalization.
- Physicians should consider celiac disease in the differential diagnosis of unexplained osteomalacia, even in the absence of overt gastrointestinal symptoms.