Endocrine Abstracts

Introduction: There are serological findings and mucosal injury similar to the classical form but no gastrointestinal symptoms in subclinical Celiac disease (CD). In this article, we present a case of subclinical CD presented with postpartum low-back pain, in whom we discovered severe lumbar vertebral osteoporosis.

Case report: A 35-year-old woman admitted to our outpatient clinic with severe low-back pain. The patient had given birth 5 months ago, and was breastfeeding. Upon physical examination, her height was 155 cm, weight was 45 kg, and BMI was 18.7 kg/m²; musculoskeletal and neurological examinations were normal. The laboratory analyses results were as follows: hemoglobin 10.2 g/dl, serum calcium 7.2 mg/dl, phosphorus 2.0 mg/dl, ALP 605 U/l, 25(OH) vitamin D <5 ng/ml, and PTH 640 pg/ml. Anti-gliadin IgG and tissue transglutaminase IgA–IgG tests were found positive. The patient’s DXA scan revealed L₁–L₄ lumbar vertebrae Z-score was −4.4. No fracture was observed in lumbar X-ray. A lower duodenal biopsy showed moderate villous blunting and cript hyperplasia. A significant increase in lamina propria infiltration by lymphoplasmacytic and neutrophilic infiltration were observed. The diagnosis of subclinical CD was made based on these findings and the patient was placed on a gluten-free diet, calcium carbonate, and vitamin D₃ treatment.

At the 3rd month follow-up visit, the patient was totally recovered from her low-back pain. Bone mineral density measurement 6 months after initiation of therapy showed a significant increase at the lumbar vertebra (Z-score: −0.2).

Conclusion: Development of osteoporosis may be accelerated in patients with subclinical CD due to the increased calcium demand in pregnancy. Subclinical CD should definitely be investigated in patients with postpartum osteoporosis. Moreover, the fact that dramatic improvement can be obtained in these patients through treatment with calcium and vitamin D should be kept in mind.