治疗乳糜泻患者绝经后骨质疏松症。
Treatment of postmenopausal osteoporosis in a patient with celiac disease.
机构信息
Department of Obstetrics and Gynecology, Division of Midlife Health, University of Virginia Health System, 2955 Ivy Road, Suite 104, PO Box 801104, Charlottesville, VA 22908, USA.
出版信息
Nat Rev Endocrinol. 2010 Mar;6(3):167-71. doi: 10.1038/nrendo.2009.272.
BACKGROUND
A 62-year-old postmenopausal woman with a family history of breast cancer, mild gastroesophageal reflux disease, iron-deficient anemia and declining BMD was seen in a specialist center for the evaluation and management of osteoporosis.
INVESTIGATIONS
Analysis of tissue transglutaminase IgA, endoscopic biopsy, serial BMD scans, FRAX calculation of osteoporotic fracture risk, Gail model calculation of breast cancer risk, assessment of blood vitamin D concentration and secondary evaluation for osteoporosis.
DIAGNOSIS
Osteoporosis, persistent after 12 years of hormone replacement therapy, and celiac disease.
MANAGEMENT
The patient was initially treated for bone loss with postmenopausal hormone replacement therapy. DXA analyses showed a continued decline in BMD despite adequate replacement of calcium and vitamin D levels and withdrawal of gluten from the patient's diet. An oral bisphosphonate was recommended with plans to reassess BMD after 1 year.
背景
一位 62 岁绝经后女性，有乳腺癌家族史，轻度胃食管反流病、缺铁性贫血和骨密度降低，到专科中心就诊以评估和治疗骨质疏松症。
检查
分析组织转谷氨酰胺酶 IgA、内镜活检、骨密度扫描、骨质疏松性骨折风险的 FRAX 计算、乳腺癌风险的 Gail 模型计算、血液维生素 D 浓度评估和骨质疏松症的二级评估。
诊断
骨质疏松症，激素替代治疗 12 年后仍持续存在，和乳糜泻。
治疗
患者最初接受绝经后激素替代疗法治疗骨质流失。DXA 分析显示，尽管钙和维生素 D 水平充足补充，并从患者饮食中去除麸质，但骨密度仍持续下降。建议口服双膦酸盐治疗，并计划在 1 年后重新评估骨密度。
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