title: Child with multiple fractures: a rare presentation of a common disease.
abstract: Bone fractures are not uncommon in paediatric age. However, when recurrent, an underlying clinical condition must not be excluded. We describe the case of a boy aged 7 years, referred for investigation of recurrent bone fractures. Personal and family histories were unremarkable. Physical examination was normal. Almost all primary bone disorders were excluded. Additional laboratory investigations ruled out the majority of secondary causes of bone fragility. Coeliac disease (CD) serologies, however, were positive, and duodenal biopsies confirmed this diagnosis (Marsh III B). On a gluten-free diet, he suffered no more fractures and the bone mineral density improved. CD was also confirmed in his asymptomatic older brother. It is essential to diagnose CD as early as possible in order to minimise the compromise in bone health and prevent other complications of the disease. First-degree relatives should always be screened for the disease, even asymptomatic ones.
authors.affiliation: Pediatric Hospital, Coimbra Hospital and Universitary Centre, Coimbra, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Dias Costa
authors.affiliation: Pediatric Gastroenterology and Nutrition Department, Pediatric Hospital, Coimbra Hospital and Universitary Centre, Coimbra, Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Maia
authors.affiliation: Pediatric Gastroenterology and Nutrition Department, Pediatric Hospital, Coimbra Hospital and Universitary Centre, Coimbra, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Almeida
authors.affiliation: Pediatric Gastroenterology and Nutrition Department, Pediatric Hospital, Coimbra Hospital and Universitary Centre, Coimbra, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ferreira
mesh_terms: D015502:Absorptiometry, Photon; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis; D002648:Child; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000209:etiology*; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D012008:Recurrence