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Treatment of postmenopausal osteoporosis in a patient with celiac disease

Nature Reviews Endocrinology volume 6, pages 167–171 (2010)Cite this article

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Abstract

Background. A 62-year-old postmenopausal woman with a family history of breast cancer, mild gastroesophageal reflux disease, iron-deficient anemia and declining BMD was seen in a specialist center for the evaluation and management of osteoporosis.

Investigations. Analysis of tissue transglutaminase IgA, endoscopic biopsy, serial BMD scans, FRAX® calculation of osteoporotic fracture risk, Gail model calculation of breast cancer risk, assessment of blood vitamin D concentration and secondary evaluation for osteoporosis.

Diagnosis. Osteoporosis, persistent after 12 years of hormone replacement therapy, and celiac disease.

Management. The patient was initially treated for bone loss with postmenopausal hormone replacement therapy. DXA analyses showed a continued decline in BMD despite adequate replacement of calcium and vitamin D levels and withdrawal of gluten from the patient's diet. An oral bisphosphonate was recommended with plans to reassess BMD after 1 year.

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Figure 1
Figure 2: Small bowel mucosa of the case patient.

References

  1. Cauley, J. A. et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial. JAMA 290, 1729–1738 (2003).

    Article  CAS  Google Scholar 

  2. Watts, N. B., Lewiecki, E. M., Miller, P. D. & Baim, S. National Osteoporosis Foundation 2008 Clinician's Guide to Prevention and Treatment of Osteoporosis and the World Health Organization Fracture Risk Assessment Tool (FRAX): what they mean to the bone densitometrist and bone technologist. J. Clin. Densitom. 11, 473–477 (2008).

    Article  Google Scholar 

  3. World Health Organization Collaborating Centre for Metabolic Bone Diseases WHO Fracture Risk Assessment Tool [online] (2009).

  4. National Osteoporosis Foundation [online] (2009).

  5. Gail, M. H. et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J. Natl Cancer Inst. 81, 1879–1886 (1989).

    Article  CAS  Google Scholar 

  6. Rostom, A. et al. The diagnostic accuracy of serologic tests for celiac disease: a systematic review. Gastroenterology 128 (Suppl. 1) S38–S46 (2005).

    Article  Google Scholar 

  7. Rostom, A., Murray, J. A. & Kagnoff, M. F. American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology 131, 1981–2002 (2006).

    Article  Google Scholar 

  8. AGA Institute. AGA Institute medical position statement on the diagnosis and management of celiac disease. Gastroenterology 131, 1977–1980 (2006).

  9. US Department of Health and Human Services. National Institutes of Health Consensus Development Conference Statement [online], (2004).

  10. Niewinski, M. M. Advances in celiac disease and gluten-free diet. J. Am. Diet Assoc. 108, 661–672 (2008).

    Article  Google Scholar 

  11. Pietzak, M. M. Follow-up of patients with celiac disease: achieving compliance with treatment. Gastroenterology 128 (Suppl. 1), S135–S141 (2005).

    Article  Google Scholar 

  12. Chapuy, M. C. et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos. Int. 7, 439–443 (1997).

    Article  CAS  Google Scholar 

  13. Olmos, M. et al. Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease. Dig. Liver Dis. 40, 46–53 (2008).

    Article  CAS  Google Scholar 

  14. Legroux-Gérot, I. et al. Screening for celiac disease in patients with osteoporosis. Joint Bone Spine 76, 162–165 (2009).

    Article  Google Scholar 

  15. Kavuncu, V., Dundar, U., Ciftci, I. H., Evcik, D. & Yigit, I. Is there any requirement for celiac disease screening routinely in postmenopausal women with osteoporosis? Rheumatol. Int. 29, 841–845 (2009).

    Article  CAS  Google Scholar 

  16. Yu, E. W. et al. Acid-suppressive medications and risk of bone loss and fracture in older adults. Calcif. Tissue Int. 83, 251–259 (2008).

    Article  CAS  Google Scholar 

  17. Roux, C. et al. Increase in vertebral fracture risk in postmenopausal women using omeprazole. Calcif. Tissue Int. 84, 13–19 (2009).

    Article  CAS  Google Scholar 

  18. Mautalen, C. et al. Effect of treatment on bone mass, mineral metabolism, and body composition in untreated celiac disease patients. Am. J. Gastroenterol. 92, 313–318 (1997).

    CAS  PubMed  Google Scholar 

  19. National Institute of Diabetes and Digestive and Kidney Diseases National Digestive Diseases Information Clearinghouse [online], (2009).

  20. Stenson, W. F., Newberry, R., Lorenz, R., Baldus, C. & Civitelli, R. Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis. Arch. Intern. Med. 165, 393–399 (2005).

    Article  Google Scholar 

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Acknowledgements

Written consent for publication was obtained from the patient. Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Midlife Health, University of Virginia Health System, 2955 Ivy Road, Suite 104, PO Box 801104, Charlottesville, 22908, VA, USA

    JoAnn V. Pinkerton

  2. Department of Medicine and Endocrinology, Endocrinology Clinic, University of Virginia Health System, 415 Ray C. Hunt Drive, PO Box 801405, Charlottesville, 22908, VA, USA

    Alan C. Dalkin

  3. Division of Gastroenterology and Hepatology, Digestive Health Center of Excellence, University of Virginia Health System, 1300 Jefferson Park Avenue, PO Box 800708, Charlottesville, 22908, VA, USA

    Sheila E. Crowe

  4. Department of Dermatology, Primary Care Center, University of Virginia Health System, 1221 Lee Street, PO Box 800718

    Barbara B. Wilson

  5. Department of Pathology, PO Box 800214, University of Virginia Health System, Charlottesville, 22908, VA, USA

    Edward B. Stelow

Authors
  1. JoAnn V. Pinkerton
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  2. Alan C. Dalkin
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  3. Sheila E. Crowe
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Corresponding author

Correspondence to JoAnn V. Pinkerton.

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Competing interests

J. V. Pinkerton declares associations with the following companies: Amgen (consultant), Boehringer Ingelheim (consultant), Eli Lilly (consultant), NovoNordisk (consultant), Pfizer (grant/research support), Wyeth (consultant, grant/research support). The other authors, the Journal Editor V. Heath and the CME questions author C. P. Vega declare no competing interests.

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Pinkerton, J., Dalkin, A., Crowe, S. et al. Treatment of postmenopausal osteoporosis in a patient with celiac disease. Nat Rev Endocrinol 6, 167–171 (2010). https://doi.org/10.1038/nrendo.2009.272

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