title: [Case report: recently diagnosed celiac disease as aggravating factor of osteoporosis in an old woman].
abstract: Sixty-three-year-old woman requested medical attention for osteoporosis. Bone densitometry revealed: T(spine (L1-L4))= -3.5 SD [Bone mineral density (BMD): 0.766 g/cm(2)]. T(femoral neck) = -2.4 SD (BMD: 0.716 g/cm(2)). She has been in calcium and vitamin D supplementation for 2 years. She informed a 5-year-history of hypothyroidism in levothyroxine replacement. Alendronate sodium 70 mg/week was initiated with significant increase in BMD in the first year (6.1% equally in spine and femoral neck). After a 5-year follow-up, the patient presented with weight loss, anemia and decrease in BMD (12.6% in spine and 20.9% in femoral neck). Clinical history revealed intermittent diarrhea episodes for 2 years and the hypothesis of celiac disease was suspected. Anti-gliadin and anti-endomysium antibodies were positive: 25.3 U/mL (< 20) e 1/5 U/mL (RV: negative), respectively. Bone biochemical parameters revealed normal levels of calcium and phosphate, increased parathyroid hormone: 283 pg/mL (10-65) and increased levels of bone reabsortion markers, consistent with secondary hyperparathyroidism in response to malabsorptive syndrome. One year after gluten-free diet, patient improved of malabsorptive symptoms and gained BMD (47.3% in spine and 31.6% in femoral neck), confirming the hypothesis of celiac disease as aggravating factor of osteoporosis in this patient.
authors.affiliation: Serviço de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. camilacanteiro@uol.com.br
authors.forename: Camila C
authors.initials: CC
authors.lastname: Pereira
authors.forename: Pedro Henrique S
authors.initials: PH
authors.lastname: Corrêa
authors.forename: Alfredo
authors.initials: A
authors.lastname: Halpern
mesh_terms: D015415:Biomarkers; D015519:Bone Density; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000178:diet therapy; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*
chemical_list: D015415:Biomarkers