Osteoporosis reversibility in a patient with celiac disease and primary autoimmune hypothyroidism on gluten free diet: A case report
Introduction. 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...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2015-01-01
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| Series: | Vojnosanitetski Pregled |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2015/0042-84501501072K.pdf |
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| Summary: | Introduction. 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. Case report. 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 g
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.
Conclusion. 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. |
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| ISSN: | 0042-8450 |