Hypocalciuria and abnormalities in mineral and skeletal homeostasis in patients with celiac sprue without intestinal symptoms

Celiac sprue may be asymptomatic in terms of the gastrointestinal tract and, as a result, may go unrecognized for long periods of time. The objective of this report is to characterize patients who only show signs of abnormalities of mineral and skeletal homeostasis. We present data from six patients seen in academic clinics who eventually were diagnosed with celiac sprue. Serum and urine biochemical tests and bone density were measured. Results showed that the patients had variable initial presentations. Biochemical findings included hypocalciuria, hypocalcemia, low serum 25-OH vitamin D and carotene levels and increased serum parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D [1,25(OH)₂D] levels. Gluten-free diet resulted in clinical improvement. Low urine calcium was a consistent finding in these patients. We conclude that celiac sprue should be considered in patients with osteopenia or hypocalcemia, even in the absence of gastrointestinal signs or symptoms.