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. 2012 Sep;16(5):780-5.
doi: 10.4103/2230-8210.100674.

Celiac disease: A missed cause of metabolic bone disease

Ashu Rastogi  1 , Sanjay K Bhadada, Anil Bhansali, Rakesh Kochhar, Ramakrishnan Santosh
Affiliations

Celiac disease: A missed cause of metabolic bone disease

Ashu Rastogi et al. Indian J Endocrinol Metab. 2012 Sep.

Abstract

Introduction: Celiac disease (CD) is a highly prevalent autoimmune disease. The symptoms of CD are varied and atypical, with many patients having no gastrointestinal symptoms. Metabolic bone disease (MBD) is a less recognized manifestation of CD associated with spectrum of musculoskeletal signs and symptoms, viz. bone pains, proximal muscle weakness, osteopenia, osteoporosis, and fracture. We here report five patients who presented with severe MBD as the only manifestation of CD.

Materials and methods: Records of 825 patients of CD diagnosed during 2002-2010 were retrospectively analyzed for clinical features, risk factors, signs, biochemical, and radiological parameters.

Results: We were able to identify five patients (0.6%) of CD who had monosymptomatic presentation with musculoskeletal symptoms and signs in the form of bone pains, proximal myopathy, and fragility fractures without any gastrointestinal manifestation. All the five patients had severe MBD in the form of osteopenia, osteoporosis, and fragility fractures. Four of the five patients had additional risk factors such as antiepileptic drugs, chronic alcohol consumption, malnutrition, and associated vitamin D deficiency which might have contributed to the severity of MBD.

Conclusion: Severe metabolic disease as the only presentation of CD is rare. Patients show significant improvement in clinical, biochemical, and radiological parameters with gluten-free diet, calcium, and vitamin D supplementation. CD should be looked for routinely in patients presenting with unexplained MBD.

Keywords: Celiac disease; fractures; metabolic bone disease; osteomalacia; osteoporosis.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Chest X-ray P-A view showing fracture of multiple ribs (arrows)
Figure 2
Figure 2
X-ray of pelvis showing triradiate pelvis, separation of pubic symphysis, and coax vara deformity of neck of left femur
Figure 3
Figure 3
X-ray legs showing healing looser's zone and fractures (arrows)
Figure 4
Figure 4
X-ray pelvis showing right hip prosthesis after replacement
See this image and copyright information in PMC

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