Stenson William F, Newberry Rodney, Lorenz Robin, Baldus Christine, Civitelli Roberto
Divisions of Gastroenterology, Washington University School of Medicine, St Louis, MO 63110, USA.
Arch Intern Med. 2005 Feb 28;165(4):393-9. doi: 10.1001/archinte.165.4.393.
There is an increased prevalence of osteoporosis among patients with celiac disease. However, the relative prevalence of celiac disease among osteoporotic and nonosteoporotic populations is not known, and the benefit of screening the osteoporotic population for celiac disease remains controversial.
We evaluated 840 individuals, 266 with and 574 without osteoporosis, from the Washington University Bone Clinic by serologic screening for celiac disease. Individuals with positive serologic test results for antitissue transglutaminase or antiendomysial antibody were offered endoscopic intestinal biopsy to confirm the diagnosis of celiac disease. Individuals with biopsy-proven celiac disease were treated with a gluten-free diet and followed up for improvement in bone mineral density.
Twelve (4.5%) of 266 patients with osteoporosis and 6 (1.0%) of 574 patients without osteoporosis tested positive by serologic screening for celiac disease. All but 2 serologically positive individuals underwent in-testinalbiopsy. Nine osteoporotic patients and 1 nonosteoporotic patient had positive biopsy results. The prevalence of biopsy-proven celiac disease was 3.4% among the osteoporotic population and 0.2% among the nonosteoporotic population. All biopsy-positive individuals tested positive by antitissue transglutaminase and antiendomysial antibody. The antitissue transglutaminase levels correlated with the severity of osteoporosis as measured by T score, demonstrating that the more severe the celiac disease the more severe the resulting osteoporosis. Treatment of the patients with celiac disease with a gluten-free diet resulted in marked improvement in T scores.
The prevalence of celiac disease among osteoporotic individuals (3.4%) is much higher than that among nonosteoporotic individuals (0.2%). The prevalence of celiac disease in osteoporosis is high enough to justify a recommendation for serologic screening of all patients with osteoporosis for celiac disease.
乳糜泻患者中骨质疏松症的患病率有所增加。然而，骨质疏松症患者和非骨质疏松症人群中乳糜泻的相对患病率尚不清楚，对骨质疏松症人群进行乳糜泻筛查的益处仍存在争议。
我们通过对华盛顿大学骨病诊所的840名个体进行乳糜泻血清学筛查，其中266名患有骨质疏松症，574名未患骨质疏松症。抗组织转谷氨酰胺酶或抗肌内膜抗体血清学检测结果呈阳性的个体接受内镜肠道活检以确诊乳糜泻。经活检证实患有乳糜泻的个体接受无麸质饮食治疗，并随访观察骨密度的改善情况。
266名骨质疏松症患者中有12名（4.5%）通过乳糜泻血清学筛查呈阳性，574名非骨质疏松症患者中有6名（1.0%）呈阳性。除2名血清学阳性个体外，所有个体均接受了肠道活检。9名骨质疏松症患者和1名非骨质疏松症患者活检结果呈阳性。经活检证实的乳糜泻患病率在骨质疏松症人群中为3.4%，在非骨质疏松症人群中为0.2%。所有活检阳性个体的抗组织转谷氨酰胺酶和抗肌内膜抗体检测均呈阳性。抗组织转谷氨酰胺酶水平与通过T评分衡量的骨质疏松症严重程度相关联，表明乳糜泻越严重，所导致的骨质疏松症就越严重。对乳糜泻患者采用无麸质饮食治疗后，T评分有显著改善。
骨质疏松症个体中乳糜泻的患病率（3.4%）远高于非骨质疏松症个体（0.2%）。骨质疏松症中乳糜泻的患病率高到足以证明推荐对所有骨质疏松症患者进行乳糜泻血清学筛查是合理的。
