FRI676 Undiagnosed Celiac Disease: A Silent Offender Of Male Osteoporosis
Authors: Hernandez Castro Ivonne E , Ludeña De Freitas Angelica M , Martinez Aguiar Mariana S , Irizarry Gabriel 
Published: October 2023

Disclosure: I.E. Hernandez Castro: None. A.M. Ludeña De Freitas: None. M.S. Martinez Aguiar: None. G. Irizarry: None.

Osteoporosis affects both genders, with higher incidence in women after menopause. In men, it's often overlooked, leading to significant morbidity and mortality, if not diagnosed and treated early. Hip fractures in men have higher mortality than in women.Celiac disease is an immune reaction to gluten, causing nutrient malabsorption and inflammation-mediated injury to the small intestine, in genetically predisposed patients. It can lead to severe osteoporosis, especially if the disease remains undiagnosed for a long time.A 64-year-old male patient who does not follow any regular medical care, was transported to the emergency department due to dizziness, blurry vision, and left arm numbness for one day evolution. Physical examination was unremarkable, no signs of tetany noted. Laboratories showed corrected calcium 4.4mg/dL, sodium 130 mEq/L, potassium 2.5 mmol/L, phosphorus 4.41. PTH intact level 465.3 pg/mL, and ionized calcium level 5.2 mg/dL, measured after supplementation. Further studies revealed 24 hours urine calcium, sodium, and creatinine 52mg/day, 107mmol/day, and 1118mg/day, respectively. DEXA scan reported low bone mineral density (BMD) at AP spine L1-L4 of 0.860 with T-score of -3.0, BMD at femur neck of 0.579 with T-score of -3.8, and BMD at femur total of 0.622 with T-score of -3.6. The latter findings indicated severe osteoporosis, a rare and unexpected finding in a male patient younger than 70 years of age. Tissue transglutaminase IgA was positive with value of 611 u/mL and serum IgA 242mg/dL. Pathology report from tissue of the duodenum reported small bowel mucosa with focal gastric foveolar metaplasia and acute duodenitis, negative for dysplasia or malignancy. Immunohistochemical study for Helicobacter Pylori was positive and biopsy findings taken from the stomach, antrum, and body revealed gastric mucosa with moderate chronic active inflammation without intestinal metaplasia. Patient was diagnosed with secondary hyperparathyroidism due to celiac disease, a well-known studied risk factor for osteoporosis. Celiac disease caused malabsorption of nutrients and electrolytes, including calcium, which is essential for bone health. A gluten-free diet and supplements of oral calcium and vitamin D were started. Antiresorptive medications for osteoporosis were not started at this moment due to hypocalcemia and vitamin D deficiency. This case highlights the importance of considering Celiac disease as an uncommon but important etiology of osteoporosis. This malabsorptive condition should always be included among the differential diagnosis in male patients presenting with unexplained electrolyte imbalance and secondary hyperparathyroidism. Approximately 20% of diagnosed osteoporosis cases are men, and early diagnosis and treatment are crucial in preventing associated morbidity and mortality, especially if complicated by a hip fracture.

Presentation: Friday, June 16, 2023