Department of Endocrinology, Diabetology and Isotope Treatment, Wroclaw Medical University, Poland.
Endokrynol Pol. 2012;63(4):270-6.
Calcium and vitamin D malabsorption in coeliac disease (CD) predispose to skeletal demineralisation. The aim of this study was to evaluate the prevalence of bone mineral density (BMD) and calcium deficiencies in adult patients with CD and assess whether a gluten-free diet is sufficiently effective for BMD restoration.
BMD and biochemical parameters of bone and mineral metabolism were measured in 35 adult CD patients receiving (19) or not receiving (16) a gluten-free diet (GFD) and in 36 controls. Then the CD patients were treated with a GFD and calcium (1.0 g/day) plus alfacalcidol (0.25-1 μg/day) for one year.
Reduced BMD was diagnosed in 57-77% of the patients. Mean calcaemia, calciuria, and 25(OH) vitamin D were lower, but serum PTH and bone-turnover markers (ALP, osteocalcin, ICTP) were significantly higher in the CD patients than in the controls. In the patients on the diet (GFD(+)), BMD was higher than in the GFD(-) patients, but lower than in the controls. The biochemical parameters were normal in the GFD(+) patients except for diminished calciuria. Mean BMD after one year of treatment significantly increased (p < 0.05), mostly in the lumbar spine (mean: 7.3%), but decreased in five patients who did not strictly adhere to the GFD.
Deficiencies in calcium, vitamin D, and BMD are very common in adult CD patients. Gluten avoidance increased BMD, although the values remained markedly lower in several patients. Because of chronic calcium deficiency despite GFD, calcium and vitamin D supplementation in most adult CD patients is proposed.
乳糜泻（CD）患者的钙和维生素 D 吸收不良会导致骨骼脱矿。本研究的目的是评估成年 CD 患者的骨密度（BMD）和钙缺乏的发生率，并评估无麸质饮食（GFD）是否足以恢复 BMD。
测量了 35 名接受（19 名）或不接受（16 名）GFD 的成年 CD 患者和 36 名对照者的 BMD 和骨代谢生化参数。然后，将 CD 患者用 GFD 治疗，并在一年内补充钙（1.0 g/天）和阿法骨化醇（0.25-1 μg/天）。
57-77%的患者被诊断为 BMD 降低。与对照组相比，CD 患者的血钙、尿钙和 25（OH）维生素 D 水平较低，而血清 PTH 和骨转换标志物（碱性磷酸酶、骨钙素、ICTP）水平较高。在接受饮食治疗的患者（GFD(+)）中，BMD 高于未接受饮食治疗的患者（GFD(-)），但低于对照组。除尿钙减少外，GFD(+)患者的生化参数均正常。经过一年的治疗，平均 BMD 显著增加（p < 0.05），主要是在腰椎（平均增加 7.3%），但有 5 名患者不严格遵守 GFD，BMD 下降。
钙、维生素 D 和 BMD 缺乏在成年 CD 患者中非常常见。避免食用麸质可增加 BMD，但在数名患者中，BMD 值仍明显较低。由于即使在 GFD 下也存在慢性钙缺乏，因此建议大多数成年 CD 患者补充钙和维生素 D。
