Severe Osteoporosis in a Young Woman With Celiac Diseases due to Vitamin D Deficiency
Bibliographic record
Abstract
Osteoporosis and other related clinical features from secondary hyperparathyroidism due to the intestinal malabsorption of vitamin D and calcium can often be misdiagnosed. Symptoms such as weight loss, gastrointestinal discomfort, hypocalcemia, anemia and neurological symptoms like paresthesia and leg pain have to be considered as celiac disease (CD)-related consequences. We report the case of a 37-year-old woman with biannual history of weight loss, extreme fatigue, chest pain, paresthesia, and leg pain. After full biochemical and endocrine assessment, we found anemia with severe iron deficiency, hypocalcemia, vitamin D deficiency and high parathyroid hormone level. Moreover, on whole body dual-energy X-ray absorptiometry, osteoporosis with diffuse metabolic changes was present, antibodies for CD were positive and renal function was normal. After these examinations, the patient was diagnosed with secondary hyperparathyroidism due to CD. Treatment with gluten-free diet, high doses of vitamin D and calcium revealed osteoporosis and hyperparathyroidism was treated for several months. Secondary hyperparathyroidism due to CD has to be considered during the evaluation of patients with weight loss, hypocalcemia, anemia and other non-specific metabolic, neurological and gastrointestinal symptoms. Early gluten-free diet treatment, high doses of vitamin D supplements and calcium must be used to treat osteoporosis and secondary hyperparathyroidism in the meantime. Treatment with bisphosphonates is not necessary for osteoporosis due to CD. J Med Cases. 2016;7(10):467-471 doi: http://dx.doi.org/10.14740/jmc2601w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".