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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
PubMed
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.

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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.

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