Metabolic Osteopathy in Late-Onset Celiac Disease



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).

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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).

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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

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Jul 16, 2017 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Metabolic Osteopathy in Late-Onset Celiac Disease
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