title: Osteoporosis reversibility in a patient with celiac disease and primary autoimmune hypothyroidism on gluten free diet--a case report.
abstract: BACKGROUND
  Secondary osteoporosis occurs in many diseases. Celiac disease-induced osteoporosis is the consequence of secondary hyperparathyroidism. Biochemical bone markers show predominance of bone resorption, thus making the bisphosphonates the first line therapy option. Intestinal mucosal changes are reversible on gluten-free diet. Osteoporosis reversibility is also possible, provided postmenopausal osteoporosis risk factors independent from celiac disease are not present.
  
  
  METHODS
  We presented a postmenopausal woman with at least a 10-year history of celiac disease prior to diagnosis, which had overt secondary hyperparathyroidism with insufficient status of vitamin D and a significant bone mass reduction. At the time of diagnosis of celiac disease the patient was receiving 250 μg of levothyroxine daily without achieving optimal substitution. Three years after the initiation of gluten-free diet the patient was without any signs and symptoms of the disease. All laboratory findings were within normal range. It was decided to treat the underlying disease and to supplement calcium and vitamin D without the initiation of bisphosponate therapy.
  
  
  CONCLUSIONS
  Osteoporosis regression justified this therapeutic approach. The presence of primary autoimmune hypothyroidism makes this case specific, since the inability for optimal substitution therapy with a high daily dose of levothyroxine provoked the suspicion of celiac disease.
authors.forename: Branka
authors.initials: B
authors.lastname: Kovačev-Zavišić
authors.forename: Tijana
authors.initials: T
authors.lastname: Ičin
authors.forename: Jovanka
authors.initials: J
authors.lastname: Novaković-Paro
authors.forename: Milica
authors.initials: M
authors.lastname: Medić-Stojanoska
authors.forename: Ivana
authors.initials: I
authors.lastname: Bajkin
mesh_terms: D002118:Calcium / Q000627:therapeutic use*; D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy*; D002762:Cholecalciferol; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000209:etiology*; D013974:Thyroxine / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000188:drug therapy / Q000209:etiology
chemical_list: D014807:Vitamin D; D002762:Cholecalciferol; D013974:Thyroxine; D002118:Calcium