HYPOCALCEMIA AND SKELETAL DISEASE AS PRESENTING FEATURES OF CELIAC-DISEASE

Objective: To describe 15 patients examined for hypo calcemia, skeleta l disease, or both in whom the diagnosis of celiac disease was subsequ ently made. Design: Observational case series. Patients: Fifteen patie nts (7 women and 8 men) were examined for hypocalcemia (n=11), skeleta l disease (n=3), or both (n=1). The diagnosis of celiac disease was su bsequently made. The mean age of the patients was 62 years, and 11 pat ients were 60 years of age or older. Results: Four patients had no gas trointestinal symptoms, 7 patients had mild or intermittent gastrointe stinal symptoms, and 4 patients had persistent diarrhea. Ten patients had experienced weight loss. The serum total alkaline phosphatase leve l was elevated in 10 of 15 patients, the parathyroid hormone level was elevated in all patients, and the urinary calcium level was low in al l 6 of the patients tested. The level of 25-hydroxyvitamin D was frank ly low in 4 patients, marginal in 8 patients, and normal in 3 patients . Bone mineral density was reduced in all 8 patients in whom it was me asured. Conclusions: Celiac disease should be considered in patients w ith unexplained metabolic bone disease or hypocalcemia, especially bec ause gastrointestinal symptoms may be absent or mild. Advanced age doe s not exclude the diagnosis of celiac disease.