Endocrine Abstracts

Introduction: Prevalence of celiac disease (gluten enteropathy) in general population is around 1:100–300. Half of these patients are women. Most common age for diagnose is third year or third to fourth decade of life, due to mild clinical signs. In the moment of diagnosis, 30% of patients already have lowered bone mineral density (BMD). Pathophysiologic mechanism for lowering BMD is secondary, regulative, intestinal hyperparathyroidism.

Aim: To trace changes in biochemical markers of bone, before and during the therapy, in two female patients of various age with celiac disease.

Materials and methods: Patient A: 21-year-old in generative period; patient B: 53-year-old, two years in menopause. After diagnosing celiac disease, patients were on ‘gluten free’ diet. Biochemical markers of bone metabolism, osteocalcin and croslaps were elevated in both patients, together with high values of parathormone and low levels of calcium in sera. This was a classic representation of secondary, regulative, intestinal hyperparathyroidism. Along with proper diet, patients were given supplementation of alphacalcidiol and calcium.

Results: During the therapy, there was significant decrease in values of crosslaps, osteocalcin and parathormone, with normalization of calcium levels in both patients. After 5 to 6 months, levels of osteocalcin in patient A and B was decreased 35.4 and 90%, respectively. Decrease of crosslaps was 41.2 and 83.5%; decrease of parathormone was 30.8 and 77.6% for patients A and B, respectively. After a year patient was diagnosed an osteoporosis and antiresorptive therapy with alendronat was induced.

Discussion and conclusion: During celiac disease there is significant increase in bone metabolism. Although there is reversibility in bone metabolism disturbances during therapy of gluten enteropathy (celiac disease), therapeutic approach differ depending on different risk factors non related to celiac disease.