Silva Joyce Timmermans Pires da, Nisihara Renato M, Kotze Luís Roberto, Olandoski Márcia, Kotze Lorete Maria da Silva
Serviço de Gastroenterologia, Hospital Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, PR, BR.
Departamento de Medicina, Universidade Positivo, Curitiba, PR, BR.
Arq Gastroenterol. 2015 Jul-Sep;52(3):176-9. doi: 10.1590/S0004-28032015000300004.
Low bone mineral density is considered an extra-intestinal manifestation of celiac disease with reduced bone mass, increased bone fragility, and risk of fractures. Celiac disease is considered a condition at high risk for secondary osteoporosis and the evaluation of bone density is very important in the clinical management of these patients.
The present study aimed to investigate bone alterations in celiac patients from Curitiba, South Region of Brazil at diagnosis, correlating the findings with age and gender.
Patients who were included in the study were attended to in a private office of the same physician from January 2009 to December 2013. The diagnosis of celiac disease was done through clinical, serological and histological findings. All data were collected from the medical charts of the patients. After the diagnosis of celiac disease, evaluation for low bone mineral density was requested by dual-energy X-ray absorptiometry (DEXA). DEXA bone densitometer was used to estimate low bone mineral density at the lumbar spine and femur.
A total of 101 patients, 82 (81.2%) female and 19 (18.8%) male subjects, with mean age of 39.0±3.03 years were included. At celiac disease diagnosis, 36 (35.6%) were younger than 30 years, 41 (40.6%) were between 31 and 50 years, and 24 (23.8%) were older than 50 years. Among the evaluated patients, 69 (68.3%) presented low bone mineral density, being 47% with osteopenia and 32% with osteoporosis. Patients who were older than 51 years and diagnosed with celiac disease presented low bone mineral density in 83.3% (20/24) of the cases. As expected, age influenced significantly the low bone mineral density findings. Among women, low bone mineral density was present with high frequency (60%) from 30 to 50 years. In patients diagnosed older than 60 years (n=8), all the women (n=5) and two of the three men had osteoporosis.
This study demonstrated that 69% of Brazilian patients with celiac disease at diagnosis had low bone mineral density, being more frequent in women older than 50 years.
低骨矿物质密度被认为是乳糜泻的一种肠外表现，伴有骨量减少、骨脆性增加和骨折风险。乳糜泻被视为继发性骨质疏松症的高危疾病，骨密度评估在这些患者的临床管理中非常重要。
本研究旨在调查巴西南部库里蒂巴市乳糜泻患者在诊断时的骨骼改变，并将结果与年龄和性别相关联。
2009年1月至2013年12月期间，纳入研究的患者在同一位医生的私人诊所就诊。通过临床、血清学和组织学检查结果诊断乳糜泻。所有数据均从患者的病历中收集。在诊断出乳糜泻后，要求采用双能X线吸收法（DEXA）评估低骨矿物质密度。使用DEXA骨密度仪估计腰椎和股骨的低骨矿物质密度。
共纳入101例患者，其中女性82例（81.2%），男性19例（18.8%），平均年龄为39.0±3.03岁。在乳糜泻诊断时，36例（35.6%）年龄小于30岁，41例（40.6%）年龄在31至50岁之间，24例（23.8%）年龄大于50岁。在评估的患者中，69例（68.3%）表现出低骨矿物质密度，其中47%为骨质减少，32%为骨质疏松。年龄大于51岁且诊断为乳糜泻的患者中，83.3%（20/24）的病例表现出低骨矿物质密度。正如预期的那样，年龄对低骨矿物质密度结果有显著影响。在女性中，30至50岁年龄段低骨矿物质密度的出现频率较高（60%）。在年龄大于60岁诊断的患者中（n = 8），所有女性（n = 5）和三名男性中的两名患有骨质疏松症。
本研究表明，69%的巴西乳糜泻患者在诊断时骨矿物质密度较低，在50岁以上女性中更为常见。
