SPECIAL PEDIATRIC ORTHOPEDY ABSTRACT: Metabolic Bone, Atraumatic Fracture and Celiac

Coeliac disease presenting with bilateral fibular stress fractures.

Gilbody J, et al.

Foot Ankle Surg. 2009;15(2):96-100. Epub 2008 Jul 18.

Trauma & Orthopaedics, Worcestershire Royal Hospitals NHS Trust, United Kingdom.

We present the case of an apparently healthy 22-year-old female who presented with atraumatic stress fractures of both fibulae. Further investigation demonstrated that she had osteopoenia secondary to occult coeliac disease. The fractures were successfully treated non-operatively. The awareness of the prevalence of occult coeliac disease is increasing due to simpler diagnostic tests, as is its significance as a cause of secondary osteoporosis. Knowing the relationship between these two conditions will help orthopaedic surgeons treating such patients to refer them promptly to appropriate specialists.


Osteomalacia and fatigue fractures in celiac disease

Jerosch J, et al.

Z Rheumatol. 1990 Mar-Apr;49(2):100-2.

Heinrich-Heine-Universität Düsseldorf, Orthopädische Klinik und Poliklinik.

We report on a 36-year-old female patient suffering from bilateral inguinal pain. The x-ray revealed significant osteoporosis of both proximal femurs with an impacted fatigue fracture of the right calcar and Looser zones at the left subtrochanteric femur. The intestinal biopsy proved coeliac disease, resulting in a secondary malabsorption. The authors conclude that osteomalacia in young patients could indicate coeliac-induced malabsorption.


Metabolic bone disease in a female patient with gluten enteropathy

Lovrić-Bencić M, et al.

Lijec Vjesn. 1996 May-Jun;118(5-6):118-21.

Klinika za bolesti srca i krvnih zila, KBC Rebro, Zagreb.

A 41-year old female patient with metabolic bone disease is presented. The disease was caused by malabsorption which developed as a result of gluten induced enteropathy. The diagnosis was confirmed by histological finding of the small intestine mucosa and bones. Following gluten-free diet, calcitriol and calcium tablets, the patient started to move independently and the bone mineralisation improved.


Severe osteomalacia due to gluten-sensitive enteropathy.

Lupattelli G, et al.

Ann Ital Med Int. 1994 Jan-Mar;9(1):40-3.

Clinica Medica I, Università degli Studi di Perugia.

This report discusses a severe case of osteomalacia due to gluten-sensitive enteropathy: it stresses the clinical features and describes an atypical form of gluten-sensitive enteropathy, in which gastroenterological symptoms were absent. Wasting and osteomalacia causing skeletal deformation with spontaneous fractures were observed in a 31-year-old woman who had marked hypophosphoremia, a tendency to low serum calcium levels and slight multi-deficiency anaemia. The patient was in a state of depression. The causes of osteomalacia and then a general malabsorption syndrome were investigated. Anti-gliadin antibodies were positive. Histological tests on duodenal mucous revealed a pattern indicative of gluten-sensitive enteropathy. A gluten-free diet was prescribed and at a check-up one month later the patient had improved markedly. Skeletal symptoms are predominant in 30% of atypical forms of gluten-sensitive enteropathy. The severity of this case was due to a late diagnosis.



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