Efficacy Alendronate for Improving Bone Mineral Density in Celiac Disease

Abstract

Purpose: Currently there is no study or report regarding using bisphosphonate in young males with osteoporosis caused by celiac disease. Case Report: A 32 year old South Asian man initially presented to a gastroenterologist after abnormal liver function tests and mild anemia were detected on a routine office visit. Physical examination was normal. Initial aminotransferases tests showed aspartate aminotransferase (AST) of 31 U/L and alanine aminotransferase (ALT) of 56 U/L. Biopsy of the second part of the duodenum showed villous atrophy with crypt elongation, replacement of surface epithelial cells by cuboidal cells with loss of brush border and increase in lymphocytes relative to the number of epithelial cells. Lamina propria showed increased plasma cells, lymphocytes and polymorphs consistent with celiac disease. Bone scan revealed osteoporosis involving lumbar spine and osteopenia involving both hips. T and age matched Z scores for lumbar spine were −2.8 and −2.4; right hip were −1.9 and −1.7; and left hip were −2.1 and −1.9. Patient was started on a strict gluten free diet and alendronate 10 mg per oral daily. Repeat biopsies of the duodenum showed regeneration of villous height and regression of crypt hyperplasia and the surface epithelium showed increased columnar cells with basal nuclei and brush borders consistent with partial restoration and improvement in celiac disease. Repeat bone scan 18 months later showed osteopenia with significant improvement of bone mineral density. Post therapy T and age matched Z scores for lumbar spine were −1.9 and −1.6; right hip were −2.0 and −1.7; and left hip were −1.7 and −1.4. No significant symptoms related to side effects of alendronate were reported during the 18 months treatment period. Repeat aminotransferases tests revealed AST of 26 U/L and ALT of 42 U/L. Conclusion: The significant increase of BMD in our patient after receiving alendronate is the first case report of alendronate treatment in celiac disease. Previous studies of alendronate therapy among men with secondary osteoporosis included only patients with long term corticosteroid treatment, low serum testosterone, and malabsorption syndrome without specific diagnosis of celiac disease. Study comparing gluten free diet therapy and gluten free diet therapy with bisphosphonate, especially in non-postmenopausal women, may reveal the efficacy of bisphosphonate in celiac disease.