A limp in a pregnant woman as a first presentation of celiac disease

Osteoporos Int. 2012 Mar;23(3):1183-6. doi: 10.1007/s00198-011-1670-6. Epub 2011 May 25.


A 25-year-old Arab woman, reported to our endocrinology clinic one month post-partum presenting with back pain and a limp that started during the seventh month of pregnancy. Upon examination, she was found to have a full range of motion and no tenderness in the hip joint or lower back. The pain was aggravated by walking. She had a limping gait with a lean to her right side. She had low calcium, low hemoglobin, high parathyroid hormone and high alkaline phosphatase levels. X-rays of her hip and lumbosacral areas were normal. Her spinal magnetic resonance imaging findings were also normal. A bone mineral density (BMD) study revealed severe osteoporosis with a lumbar spine T-score of -4.6 and femoral neck T-scores of -4.1 (left) and -3.9 (right). A celiac disease work-up included tests for anti-endomysial antibodies and anti-tissue transglutaminase antibodies, which were positive, and the results of an endoscopy and biopsy confirmed the diagnosis of celiac disease. Gluten-free diet with calcium and vitamin D supplementation resulted in the complete resolution of her symptoms and a normal gait. The patient returned to normal calcium and parathyroid hormone levels and experienced a significant improvement in her BMD to normal. Celiac disease may initially presents during pregnancy result in severe osteoporosis that causes significant pain and disability.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Celiac Disease / complications
  • Celiac Disease / diagnosis*
  • Diagnosis, Differential
  • Female
  • Gait*
  • Humans
  • Low Back Pain / etiology
  • Osteoporosis / diagnosis
  • Osteoporosis / etiology*
  • Pregnancy
  • Pregnancy Complications*