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).

A352678_1_En_20_Fig2_HTML.gif


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).

A352678_1_En_20_Fig3_HTML.gif


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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