Valdimarsson T, Toss G, Löfman O, Ström M
Dept. of Health and Environment, Faculty of Health Sciences, Linköping University, Sweden.
Scand J Gastroenterol. 2000 Mar;35(3):274-80. doi: 10.1080/003655200750024146.
The mechanisms of disturbances in bone mineral density (BMD) in coeliac disease are not completely understood. The aim of this prospective study was to investigate the possible significance of secondary hyperparathyroidism (SHPT) with regard to BMD in patients with untreated coeliac disease.
One hundred and five adult patients with untreated coeliac disease were examined for BMD and serum parathyroid hormone (PTH) concentration. BMD in the hip, lumbar spine, and forearm were examined up to 3 years after the introduction of a gluten-free diet.
SHPT was found in 27% (28 of 105) of the patients. In patients with SHPT serum levels of 25-hydroxy-vitamin D were lower and those of alkaline phosphatase higher than in patients with normal PTH, but ionized serum calcium did not differ between the two groups. BMD was more severely reduced in patients with SHPT. Although the BMD increment was more rapid in patients with than in those without SPTH, only in the latter group did mean BMD became normal after 1-3 years on a gluten-free diet (GFD). After 3 years on a GFD more than half of the patients with initial SHPT still had low BMD in both the hip and the forearm. Furthermore, in patients with SHPT the intestinal mucosa more often remained atrophic at the 1-year follow-up, despite good compliance with the diet.
Low BMD in patients with untreated coeliac disease is often associated with SHPT. After 3 years on a GFD the BMD remains low only in patients with initial SHPT. We therefore suggest that PTH should be measured when the diagnosis of coeliac disease is made, as an indicator of more serious intestinal disorder and complicating bone disease.
乳糜泻患者骨矿物质密度（BMD）紊乱的机制尚未完全明确。这项前瞻性研究的目的是探讨继发性甲状旁腺功能亢进（SHPT）对未经治疗的乳糜泻患者骨密度的可能影响。
对105例未经治疗的成年乳糜泻患者进行骨密度和血清甲状旁腺激素（PTH）浓度检测。在采用无麸质饮食后长达3年的时间里，对髋部、腰椎和前臂的骨密度进行检测。
27%（105例中的28例）的患者存在SHPT。与PTH正常的患者相比，SHPT患者的血清25-羟维生素D水平较低，碱性磷酸酶水平较高，但两组间血清离子钙水平无差异。SHPT患者的骨密度降低更为严重。尽管SHPT患者的骨密度增加速度比无SHPT的患者更快，但只有后者在采用无麸质饮食（GFD）1 - 3年后平均骨密度恢复正常。采用GFD 3年后，半数以上初始患有SHPT的患者髋部和前臂骨密度仍较低。此外，在随访1年时，尽管严格遵守饮食规定，但SHPT患者的肠黏膜萎缩更为常见。
未经治疗的乳糜泻患者骨密度降低通常与SHPT有关。采用GFD 3年后，只有初始患有SHPT的患者骨密度仍低。因此，我们建议在诊断乳糜泻时检测PTH，作为更严重肠道疾病和并发骨病的指标。
