Relato de caso: doença celíaca recém-diagnosticada como fator agravante de osteoporose em mulher idosa

Abstract

Sixty-three-year-old woman requested medical attention for osteoporosis. Bone densitometry revealed: T(spine (L1-L4))= -3.5 SD [Bone mineral density (BMD): 0.766 g/cm(2)]. T(femoral neck) = -2.4 SD (BMD: 0.716 g/cm(2)). She has been in calcium and vitamin D supplementation for 2 years. She informed a 5-year-history of hypothyroidism in levothyroxine replacement. Alendronate sodium 70 mg/week was initiated with significant increase in BMD in the first year (6.1% equally in spine and femoral neck). After a 5-year follow-up, the patient presented with weight loss, anemia and decrease in BMD (12.6% in spine and 20.9% in femoral neck). Clinical history revealed intermittent diarrhea episodes for 2 years and the hypothesis of celiac disease was suspected. Anti-gliadin and anti-endomysium antibodies were positive: 25.3 U/mL (< 20) e 1/5 U/mL (RV: negative), respectively. Bone biochemical parameters revealed normal levels of calcium and phosphate, increased parathyroid hormone: 283 pg/mL (10-65) and increased levels of bone reabsortion markers, consistent with secondary hyperparathyroidism in response to malabsorptive syndrome. One year after gluten-free diet, patient improved of malabsorptive symptoms and gained BMD (47.3% in spine and 31.6% in femoral neck), confirming the hypothesis of celiac disease as aggravating factor of osteoporosis in this patient.

Gluten Sensitivity Presenting as a Neuropsychiatric Disorder

“…Furthermore, similar reports are published dealing with various other neurological manifestations in response to gluten exposure including “idiopathic” ataxia and neuropathies [11], epilepsy [12], mood swings [6], and autism [13]. In addition to neuropsychiatric phenomena, there are reports of other organ system involvement including reversible cardiomyopathy [14], resolved primary infertility [15], uveitis [16], and osteoporosis [17] in relation to the gluten exposure in celiac disease.…”

Complicações Da Doença Celíaca Associada Ao Transgresso À Dieta Isenta De Glúten

“…A osteoporose 15 , diabetes mellitus tipo I (DMI) 16,17 , tireoidite de Hashimoto 18 e linfoma, estão na lista de doenças que são associadas como complicações que surgem por meio da DC. Uma variedade de doenças desencadeadas por mecanismos autoimunes ou ligadas a antígenos da classe HLA (Human Leukocyte Antigen/Antígeno Leucocitário Humano) 19 .…”

O acompanhamento clínico de crianças e adolescentes celíacos em meio à pandemia de Covid-19: uma revisão integrativa da literatura.

“…Uma das consequências relevantes da doença celíaca é a perda de massa óssea. Muitos indivíduos celíacos podem apresentar comprometimento da mineralização óssea, levando a quadros de perda de massa óssea e desenvolvimento de osteoporose futura (PEREIRA; CORRÊA; HALPERN, 2006).…”