|
|
|
Case Study 1
A 65-year old woman with bone
loss and celiac disease
Submitted by Marjorie M. Luckey, MD
Director, Saint Barnabas Osteoporosis and
Metabolic Center, Livingston, NJ;
Associate Clinical Professor,
Mount Sinai School of Medicine,
New York, NY
PATIENT PROFILE
Mary R. is a 65-year-old healthy Caucasian
woman (height 5' 2",weight 125 lbs), who
recently retired as a secretary. She has had
six pregnancies with normal outcomes.
Menopause began at age 50; she has never
taken estrogen. Her history includes longstanding
symptoms of irritable bowel
syndrome. She has never smoked and her
alcohol intake is minimal. She takes a multivitamin,
600 mg calcium carbonate, and
200 IU vitamin D daily. She also drinks
one glass of milk and one glass of calciumfortified
orange juice daily. Her bone mineral
density (BMD) results are listed in the
table below.
Lab results were normal for serum calcium,
phosphorus, alkaline phosphatase, CBC,
and differential. Her 25 OH vitamin D was
28 ng/mL and 24-hour urine calcium was
30 mg/24 hr. Tests for antigliadin antibodies
and transglutaminase antibody were strongly
positive. A small-bowel biopsy confirmed
the presence of celiac disease.
DISCUSSION
This patient's low Z-score suggests that
something other than (or in addition to)
postmenopausal bone loss is occurring.
The patient's long-standing irritable bowel
syndrome (IBS) is an important clue: a
major proportion of IBS patients have gluten
sensitivity. Celiac disease is an inherited
disorder caused by intolerance to the gliadin
fraction of gluten. Gliadin combines with
antibodies, forming an immune complex
that damages the intestinal mucosa. The
disease has a major impact on calcium
absorption. Her 24-hour urine calcium
confirmed the presence of calcium malabsorption.
Thus, Mary R.'s celiac disease must
be addressed before her bone loss can be
treated effectively. This case underscores the
importance of a laboratory work-up to rule
out secondary causes of osteoporosis.
Return to [VCU-CME.org]
|
|
|
