Severe Osteoporosis in a Young Woman With Celiac Diseases due to Vitamin D Deficiency

Osteoporosis and other related clinical features from secondary hyperparathyroidism due to the intestinal malabsorption of vitamin D and calcium can often be misdiagnosed. Symptoms such as weight loss, gastrointestinal discomfort, hypocalcemia, anemia and neurological symptoms like paresthesia and leg pain have to be considered as celiac disease (CD)-related consequences. We report the case of a 37-year-old woman with biannual history of weight loss, extreme fatigue, chest pain, paresthesia, and leg pain. After full biochemical and endocrine assessment, we found anemia with severe iron deficiency, hypocalcemia, vitamin D deficiency and high parathyroid hormone level. Moreover, on whole body dual-energy X-ray absorptiometry, osteoporosis with diffuse metabolic changes was present, antibodies for CD were positive and renal function was normal. After these examinations, the patient was diagnosed with secondary hyperparathyroidism due to CD. Treatment with gluten-free diet, high doses of vitamin D and calcium revealed osteoporosis and hyperparathyroidism was treated for several months. Secondary hyperparathyroidism due to CD has to be considered during the evaluation of patients with weight loss, hypocalcemia, anemia and other non-specific metabolic, neurological and gastrointestinal symptoms. Early gluten-free diet treatment, high doses of vitamin D supplements and calcium must be used to treat osteoporosis and secondary hyperparathyroidism in the meantime. Treatment with bisphosphonates is not necessary for osteoporosis due to CD. J Med Cases. 2016;7(10):467-471 doi: http://dx.doi.org/10.14740/jmc2601w