Celiac Disease in Patients with Cystic Fibrosis-Related Bone Disease.

Melissa S Putman,Leonard Sicilian,Alexandra Haagensen,Isabel Neuringer

doi:10.1155/2017/2652403

Melissa S Putman, Leonard Sicilian + Show 2 more

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https://doi.org/10.1155/2017/2652403

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Abstract

Both cystic fibrosis (CF) and celiac disease can cause low bone mineral density (BMD) and fractures. Celiac disease may occur at a higher frequency in patients with CF than the general population, and symptoms of these conditions may overlap. We report on two patients presenting with CF-related bone disease in the past year who were subsequently found to have concurrent celiac disease. Because adherence to a gluten-free diet may improve BMD in patients with celiac disease, this could have important implications for treatment. Clinicians should consider screening for celiac disease in patients with CF who have low BMD, worsening BMD in the absence of other risk factors, and/or difficult to treat vitamin D deficiency.

Highlights

Cystic fibrosis (CF) is one of the most common autosomal recessive disorders among Caucasian populations, affecting approximately one in 3000 live births
We report two cases of young adults who presented to our CF Center Endocrine Clinic in the past year with CF-related bone disease and upon further evaluation were subsequently diagnosed with concurrent celiac disease
Celiac disease was discovered in young adults with CF who had significantly low bone mineral density (BMD) Zscores by Dual energy X-ray absorptiometry (DXA), and one patient had a marked decline in BMD despite few other risk factors for progressive bone loss

Summary

Introduction

Cystic fibrosis (CF) is one of the most common autosomal recessive disorders among Caucasian populations, affecting approximately one in 3000 live births. Children and adults with CF are at risk for low bone density and fractures due to multiple potential risk factors including vitamin D deficiency, delayed puberty, hypogonadism, pancreatic insufficiency causing malabsorption, compromised nutrition, glucocorticoid use, reduced physical activity, and possibly CF transmembrane conductance regulator (CFTR) dysfunction itself [2, 3]. The symptoms of celiac disease may be difficult to distinguish from those related to CF, in patients with malabsorption from pancreatic insufficiency. The combination of these two conditions may result in a significant insult to skeletal health. We report two cases of young adults who presented to our CF Center Endocrine Clinic in the past year with CF-related bone disease and upon further evaluation were subsequently diagnosed with concurrent celiac disease

Case 1

Case 2

Findings

Discussion