Background: A 62-year-old postmenopausal woman with a family history of breast cancer, mild gastroesophageal reflux disease, iron-deficient anemia and declining BMD was seen in a specialist center for the evaluation and management of osteoporosis.
Investigations: Analysis of tissue transglutaminase IgA, endoscopic biopsy, serial BMD scans, FRAX calculation of osteoporotic fracture risk, Gail model calculation of breast cancer risk, assessment of blood vitamin D concentration and secondary evaluation for osteoporosis.
Diagnosis: Osteoporosis, persistent after 12 years of hormone replacement therapy, and celiac disease.
Management: The patient was initially treated for bone loss with postmenopausal hormone replacement therapy. DXA analyses showed a continued decline in BMD despite adequate replacement of calcium and vitamin D levels and withdrawal of gluten from the patient's diet. An oral bisphosphonate was recommended with plans to reassess BMD after 1 year.
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| http://dx.doi.org/10.1038/nrendo.2009.272 | DOI Listing |
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