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Child with multiple fractures: a rare presentation of a common disease
  1. Filipa Dias Costa1,
  2. Carla Maia2,
  3. Susana Almeida2,
  4. Ricardo Ferreira2
  1. 1Pediatric Hospital, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
  2. 2Pediatric Gastroenterology and Nutrition Department, Pediatric Hospital, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
  1. Correspondence to Dr Filipa Dias Costa, filipacdcosta{at}


Bone fractures are not uncommon in paediatric age. However, when recurrent, an underlying clinical condition must not be excluded. We describe the case of a boy aged 7 years, referred for investigation of recurrent bone fractures. Personal and family histories were unremarkable. Physical examination was normal. Almost all primary bone disorders were excluded. Additional laboratory investigations ruled out the majority of secondary causes of bone fragility. Coeliac disease (CD) serologies, however, were positive, and duodenal biopsies confirmed this diagnosis (Marsh III B). On a gluten-free diet, he suffered no more fractures and the bone mineral density improved. CD was also confirmed in his asymptomatic older brother. It is essential to diagnose CD as early as possible in order to minimise the compromise in bone health and prevent other complications of the disease. First-degree relatives should always be screened for the disease, even asymptomatic ones.

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  • Contributors FDC was involved in the diagnostic work-up and drafted the manuscript. CM and RF were responsible for the patients’ diagnosis and follow-up. SA made significant contributions to the content of the manuscript. SA, CM and RF were involved in critically reviewing the data. RF gave final approval of the version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.