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Treatment of postmenopausal osteoporosis in a patient with celiac disease
JoAnn V Pinkerton1, Alan C Dalkin, Sheila E Crowe
1Department of Obstetrics and Gynecology, Division of Midlife Health, University of Virginia Health System, 2955 Ivy Road, Suite 104, PO Box 801104, Charlottesville, VA 22908, USA. jvp9u@virginia.edu
Background:
A 62-year-old postmenopausal woman with a family history of breast cancer, mild gastroesophageal reflux disease, iron-deficient anemia and declining BMD was seen in a specialist center for the evaluation and management of osteoporosis.
Investigations:
Analysis of tissue transglutaminase IgA, endoscopic biopsy, serial BMD scans, FRAX calculation of osteoporotic fracture risk, Gail model calculation of breast cancer risk, assessment of blood vitamin D concentration and secondary evaluation for osteoporosis.
Diagnosis:
Osteoporosis, persistent after 12 years of hormone replacement therapy, and celiac disease.
Management:
The patient was initially treated for bone loss with postmenopausal hormone replacement therapy. DXA analyses showed a continued decline in BMD despite adequate replacement of calcium and vitamin D levels and withdrawal of gluten from the patient's diet. An oral bisphosphonate was recommended with plans to reassess BMD after 1 year.
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