Fig. 20.1
Case study 1. Bone densitometry demonstrates skeletal demineralization with L-spine BMD value of 0.910 g/cm2 and T-score −2.4, femoral neck BMD value of 0.819 g/cm2 and T-score −0.8, and forearm T-score −5.3
In order to find the cause of osteopathy, iliac crest bone trephine biopsy was performed, and the sample was examined histomorphometrically, confirming osteomalacia (atrophic cancellous bone trabeculae covered with a massive layer of demineralized bone tissue, osteoid; Fig. 20.2).
Fig. 20.2
Case report 1. Detail of bone trabecula lined by osteoid with activated osteoblasts on its surface (HE staining). Trabecula (atrophic) of cancellous bone covered with a massive layer of demineralized bone tissue, i.e., osteoid. Proportional hematopoiesis in surrounding chambers (Goldner staining)
Abdominal sonography proved marked meteorism that spontaneously subsided. Ultrasonography and CT examination of parathyroid glands has not proved any pathological process in this location.
Histological examination of the intestinal mucosa described a finding typical of celiac disease: total atrophy of resorptive epithelium of small intestine with crypt hyperplasia and increased lymphoplasmacytic cellularization in the lamina propria with dispersion pattern of eosinophilic leukocytes (Fig. 20.3, Table 20.1).
Fig. 20.3
Case report 1. Small intestinal mucosa with total atrophy of resorptive epithelium, crypt hyperplasia, and increased lymphoplasmacytic cellularization in the lamina propria with dispersion pattern of eosinophilic leukocytes (Marsh III.c; hematoxylin-eosin staining)
Table 20.1
Comparison of laboratory and clinical findings in patients
Patient 1 | Patient 2 | Normal laboratory values | |
---|---|---|---|
Age | 57 | 64 | – |
Hb | 115 | 111 | 120–160 g/l |
Ery | 3.85 | 4.76 | 3.8–4.9 ・ 1012/l |
Hct | 0.35 | 0.36 | 0.37–0.47 |
MCV | 90.1 | 75.8 | 82–96 f |
Leu | 5.73 | 4.40 | 4–10 ・ 109/l |
Thromb | 277 | 302 | 150–400 ・ 109/l |
INR | 2.5 | 1.16 | 0.9–1.25 |
ALP (total) | 3.06 | 14.13 | 0–2.1 μkat/l |
Bone fraction ALP | 2.05 | 13.43 | 20–74 % |
Fe | 7.8 | 6.4 | 14.5–26 μmol/l |
Fe binding capacity | 76 | 66.6 | 44.8–71.6 μmol/l |
Ferritin | 4.5 | 3.2 | 20–150 ng/ml |
Folate | 3.1 | 1.7 | 3–12.1 μg/l |
Vitamin B12 | 100 | 177 | 179–915 ng/l |
Ca | 2.09 | 2.18 | 2.1–2.9 mmol/l |
P | 1.31 | 0.78 | 0.8–1.6 mmol/l |
PTH | 204 | 741.1 | 10–69 ng/l |
CRP | 11.6 | <1.0 | 0–12 g/l |
Total protein | 53.7 | 69.5 | 65–85 g/l |
Albumin | 30 | 39 | 43–51 g/l |
DEXA L-spine Proximal femur Forearm | BMD 0.910; T = −2.4 BMD 0.819; T = −0.8 BMD 0.358; T = −5.3 | BMD 0.740; T = −6.7 BMD 0.835; T = −4.3 BMD 0.497; T = −7.2 | T-score above −1,0 Osteopenia −1.0 to −2.5 Osteoporosis above −2.5 |
Radiography of spine | Osteoporosis | Osteoporosis | – |
Bone histomorphometry | Osteomalacia | Osteomalacia | – |
Histology of intestinal mucosa | Total atrophy of resorptive epithelium of small intestine | Unevaluable sample | – |
Anti-gliadin antibodies: − AGA-A – AGA-G | Positive Positive | Positive Negative | Negative
Stay updated, free articles. Join our Telegram channelFull access? Get Clinical TreeGet Clinical Tree app for offline access |