Christopher P generic cialis 20mg . Nelson, Ph.D., Stephen E. Hamby, Ph.D., Danish Saleheen, M.B., B.S., Ph.D., Jenna C. Hopewell, Ph.D., Lingyao Zeng, M.Sc., Themistocles L. Assimes, M.D., Ph.D., Stavroula Kanoni, Ph.D., Christina Willenborg, Ph.D., Stephen Burgess, Ph.D., Phillipe Amouyel, M.D., Ph.D., Sonia Anand, F.R.C.P.C., Stefan Blankenberg, M.D., Bernhard O. Boehm, M.D., Robert J. Clarke, F.R.C.P., Rory Collins, F.R.C.P.E., George Dedoussis, Ph.D., Martin Farrall, F.R.C.Route., Paul W. Franks, Ph.D., Leif Groop, M.D., Ph.D., Alistair S. Hall, F.R.C.P., Anders Hamsten, M.D., Ph.D., Christian Hengstenberg, M.D., G. Kees Hovingh, M.D., Ph.D., Erik Ingelsson, M.D., Ph.D., Sekar Kathiresan, M.D., Frank Kee, M.D., Inke R.D., Jaspal Kooner, F.R.C.P.D., Ph.D.D., Ruth McPherson, F.R.C.P.C., Andres Metspalu, M.D., Ph.D., Markku S.
Although osteoporosis is usually an established complication of celiac disease,1 it is generally considered to be secondary to malabsorption and deficiencies of calcium and supplement D, rather than a consequence of an autoimmune process.1-3 We describe an individual who had celiac disease and autoimmune hypothyroidism and in whom high-turnover osteoporosis developed in association with the presence of neutralizing autoantibodies against osteoprotegerin, an inhibitor of bone resorption made by osteoblasts and many other types of cells. The antibodies blocked the inhibitory effect of osteoprotegerin on the RANK signaling pathway. The RANK receptor plays a key role in the regulation of bone remodeling.4 When activated by the RANK ligand , a signaling cascade is set up, leading to osteoclast differentiation and increased bone resorption.