Hypocalcemia and skeletal disease as presenting features of celiac disease

Objective: To describe 15 patients examined for hypo calcemia, skeletal disease, or both in whom the diagnosis of celiac disease was subsequently made. Design: Observational case series. Patients: Fifteen patients (7 women and 8 men) were examined for hypocalcemia (n=11), skeletal disease (n=3), or both (n=1). The diagnosis of celiac disease was subsequently made. The mean age of the patients was 62 years, and 11 patients were 60 years of age or older. Results: Four patients had no gastrointestinal symptoms, 7 patients had mild or intermittent gastrointestinal symptoms, and 4 patients had persistent diarrhea. Ten patients had experienced weight loss. The serum total alkaline phosphatase level was elevated in 10 of 15 patients, the parathyroid hormone level was elevated in all patients, and the urinary calcium level was low in all 6 of the patients tested. The level of 25-hydroxyvitamin D was frankly 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 measured. Conclusions: Celiac disease should be considered in patients with unexplained metabolic bone disease or hypocalcemia, especially because gastrointestinal symptoms may be absent or mild. Advanced age does not exclude the diagnosis of celiac disease.