Child with multiple fractures: a rare presentation of a common disease

Costa, Filipa Dias; C, Maia; Almeida, Susana; Ferreira, Raquel

doi:10.1136/bcr-2016-218477

Cited by 5 publications

(4 citation statements)

References 16 publications

(23 reference statements)

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“…The authors of these reports emphasize that underlying CD should be considered in patients presenting with stress fractures, even in the absence of typical clinical features. 9,21,35 In our cohort, only 1 patient complained of abdominal symptoms. Mulder et al 23 report a case of a 29-year-old man with nontraumatic multiple vertebrate fractures with severe osteopenia who was found to have CD.…”

Section: Discussionmentioning

confidence: 75%

“…Eight reported cases of BSIs being the first presentation of CD were identified in the literature. 9,22,23,[33][34][35] Interestingly, most reports are among patients with bilateral or multiple fractures in the presence of factors which increase the suspicion of an underlying metabolic disease, such as vitamin D deficiency and other metabolic abnormalities. The fractures in these cases seem not to be related to increases in activity load.…”

Section: Celiac Disease and Stress Fracturesmentioning

confidence: 99%

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Incidence of Undiagnosed Celiac Disease Presenting as Bone Stress Injuries to a Sport and Exercise Medicine Clinic

Smith

Baldock

Fitzpatrick

et al. 2020

Clinical Journal of Sport Medicine

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Objective: To evaluate the incidence of undiagnosed celiac disease (CD) in patients presenting with bone stress injuries (BSI) to a NHS Sport and Exercise Medicine (SEM) clinic. Design: Retrospective cohort study. Setting: Single tertiary-level SEM clinic. Patient/Participants: One hundred consecutive patients with radiologically proven BSIs. Interventions: Laboratory blood tests (LBT) can unmask underlying metabolic bone disorders. Anti-tissue transglutaminase antibody (TTG) testing has a high sensitivity and specificity for CD. In this SEM clinic, clinicians were encouraged to perform LBT including TTG, at time of diagnosis of BSI. A retrospective analysis of age, sex, fracture site, co-morbidities, TTG result, and subsequent investigations was performed. Main Outcome Measures: The primary outcome was the number and percentage of patients with BSIs and either positive TTG (CD seropositivity) or a diagnosis of CD. Results: Of the 100 patients with radiologically proven BSIs, 70% were female, and the mean age was 37 years (range 16-69). Eighty-five percent had the appropriate LBTs, of which 70% (60/85) were female, and the mean age was 37(16-69). Metatarsal (35%) and tibial (21%) were the most common BSIs. Anti-tissue transglutaminase antibody was performed in 85 patients. Two patients (2/85) had pre-existing CD and were excluded from incidence calculations. Five patients [5/83 (6%), mean age 38 years (28-57), 80% female] had a positive TTG, of whom 3 have subsequently had CD confirmed by endoscopic biopsy. Four patients with a positive TTG underwent dual-energy X-ray absorptiometry with osteopenia found in 3 (75%) cases. Conclusions: In this cohort, the incidence of CD seropositivity was 6%, and the prevalence of biopsy-confirmed CD was 5%, approximately 5-fold higher than UK population estimates. Anti-tissue transglutaminase antibody screening for CD should be considered in all patients presenting with BSIs.

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Section: Discussionmentioning

confidence: 75%

Section: Celiac Disease and Stress Fracturesmentioning

confidence: 99%

Incidence of Undiagnosed Celiac Disease Presenting as Bone Stress Injuries to a Sport and Exercise Medicine Clinic

Smith

Baldock

Fitzpatrick

et al. 2020

Clinical Journal of Sport Medicine

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“…Закономерно, что частота переломов у детей и подростков с целиакией значительно превосходит таковую в популяции здоровых детей. Средний возраст первого эпизода перелома, согласно данным ряда исследований, одинаков у пациентов с глютеновой энтеропатией и в общей популяции, однако частота переломов выше у пациентов с целиакией [4,21].…”

Section: Difficult Diagnosisunclassified

Bone fractures in children with celiac disease: analysis of clinical and anthropometric measurements and bone metabolism markers

Klimov,

Kuryaninova,

Cherkasova

et al. 2023

Medicinskij sovet

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Introduction. Abnormal bone remodelling process is one of the clinical manifestations of celiac disease, which increases the risk of developing osteopenia conditions, including bone fractures. The median age for the first fracture is similar in celiac disease and in the general population, but the incidence is higher in patients with celiac disease.Aim. To compare clinical and anamnestic characteristics, anthropometric measurements and laboratory test results in celiac children and adolescents with and without bone fractures.Materials and methods. A total of 151 children aged 1-17 years were included in the study. Patients were divided into two groups: those who had fractures in their lifetime - 21 (13.9%) children and those who had no fractures - 130 (86.1%) children. Results. The frequency of fractures among the patients included in the study was 13.9%, while among children with vitamin D deficiency fractures were reported 2.7 times more often than among children with its optimal level (p = 0.019).Vitamin D deficiency was detected in 20 (95.2%) children with fractures, and levels of 30 ng/ml or higher were found in 1 (4.8%) child. In the group of patients without fractures, the 25(OH)D optimal level was observed in 43 (33.1%) cases.It was found that patients with fractures had a significantly lower osteocalcin level than children without fractures - 26.9 (15.6; 32.9) ng/ml (p < 0.001), and children with fractures had C-terminal telopeptide level 1.9 times higher than the group of children without fractures (p = 0.01). The median PTH concentration in children with fractures was 34.6 (19.6; 54.7) pg/ml, whereas in children without fractures it was 24.2 (17.1; 39.5) pg/ml (p = 0.1).Conclusion. Due to elevated PTH level and severe vitamin D deficiency, a predominance of osteoresorption over osteosynthesis was observed in children with celiac disease and fractures of tubular bones. It is important to maintain a 25(OH)D optimal level and monitor biochemical markers of bone metabolism in patients with celiac disease to assess the processes of bone formation and resorption.

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“…Osteoporosis might be the sole presentation of undiagnosed CeD without gastrointestinal symptoms or even detected later in the course of the disease [ 15 , 16 , 17 ]. The prevalence of osteoporosis in adults diagnosed with celiac disease is highly variable, probably depending, among other factors, on the severity and the duration of the condition when diagnosed.…”

Section: Introductionmentioning

confidence: 99%

The Dietary and Non-Dietary Management of Osteoporosis in Adult-Onset Celiac Disease: Current Status and Practical Guidance

Al–Toma

Herman²,

Lems³

et al. 2022

Nutrients

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Impaired bone mineral density (BMD) is a frequent complication of adult-onset celiac disease (CeD). This is usually due to malabsorption of nutrients, changes in bone metabolism in association with inflammation, and to a lesser extent, decreased overall physical health and mobility. This review aims to highlight the current status concerning surveillance, prevention, and treatment strategies for bone disease in CeD. A practical guidance on these matters is suggested. The available published research on the prevention and treatment of decreased BMD in relation to CeD is scarce. In general, publications were based on expert opinions or extrapolation from studies on postmenopausal women or inflammatory bowel disease. Optimal dietary treatment and an adequate supply of calcium and vitamin D are the cornerstones for the reduction in fracture risk in patients with CeD. In adults with low BMD or fragility fractures, CeD needs to be considered and specifically approached. When osteoporosis is documented, start treatment with an antiresorptive agent; these agents are proven to result in a long-term reduction in fracture risk in high-risk individuals. However, there are some important differences between the management of male and female patients, particularly premenopausal women, that need to be addressed. In patients with persisting diarrhea and malabsorption, parenteral medications may be preferable. Future research specifically focusing on celiac disease and the associated disorders in bone mineralization is mandatory to provide evidence-based recommendations in this field.

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Child with multiple fractures: a rare presentation of a common disease

Cited by 5 publications

References 16 publications

Incidence of Undiagnosed Celiac Disease Presenting as Bone Stress Injuries to a Sport and Exercise Medicine Clinic

Incidence of Undiagnosed Celiac Disease Presenting as Bone Stress Injuries to a Sport and Exercise Medicine Clinic

Bone fractures in children with celiac disease: analysis of clinical and anthropometric measurements and bone metabolism markers

The Dietary and Non-Dietary Management of Osteoporosis in Adult-Onset Celiac Disease: Current Status and Practical Guidance

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