Zanchetta María Belén, Longobardi Vanesa, Costa Florencia, Longarini Gabriela, Mazure Roberto Martín, Moreno María Laura, Vázquez Horacio, Silveira Fernando, Niveloni Sonia, Smecuol Edgardo, de la Paz Temprano María, Massari Fabio, Sugai Emilia, González Andrea, Mauriño Eduardo César, Bogado Cesar, Zanchetta José R, Bai Julio César
Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.
Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina.
J Bone Miner Res. 2017 Jan;32(1):135-142. doi: 10.1002/jbmr.2922. Epub 2016 Oct 3.
We have recently identified a significant deterioration of bone microarchitecture in premenopausal women with newly diagnosed celiac disease (CD) using high-resolution peripheral quantitative computed tomography (HRpQCT). The aim of this work was to assess changes in bone microarchitecture after 1 year on a gluten-free diet (GFD) in a cohort of premenopausal women. We prospectively enrolled 31 consecutive females at diagnosis of CD; 26 of them were reassessed 1 year after GFD. They all underwent HRpQCT scans of distal radius and tibia, areal BMD by DXA, and biochemical tests (bone-specific parameters and CD serology) at both time points. Secondary, we compared 1-year results with those of a control group of healthy premenopausal women of similar age and BMI in order to assess whether the microarchitectural parameters of treated CD patients had reached the values expected for their age. Compared with baseline, the trabecular compartment in the distal radius and tibia improved significantly (trabecular density, trabecular/bone volume fraction [BV/TV] [p < 0.0001], and trabecular thickness [p = 0.0004]). Trabecular number remained stable in both regions. Cortical density increased only in the tibia (p = 0.0004). Cortical thickness decreased significantly in both sites (radius: p = 0.03; tibia: p = 0.05). DXA increased in all regions (lumbar spine [LS], p = 0.01; femoral neck [FN], p = 0.009; ultradistal [UD] radius, p = 0.001). Most parameters continued to be significantly lower than those of healthy controls. This prospective HRpQCT study showed that most trabecular parameters altered at CD diagnosis improved significantly by specific treatment (GFD) and calcium and vitamin D supplementation. However, there were still significant differences with a control group of women of similar age and BMI. In the prospective follow-up of this group of patients we expect to be able to assess whether bone microarchitecture attains levels expected for their age. © 2016 American Society for Bone and Mineral Research.
我们最近使用高分辨率外周定量计算机断层扫描（HRpQCT）发现，新诊断为乳糜泻（CD）的绝经前女性骨微结构显著恶化。这项研究的目的是评估一组绝经前女性在采用无麸质饮食（GFD）1年后骨微结构的变化。我们前瞻性地招募了31名在诊断为CD时的连续女性；其中26名在GFD 1年后重新接受评估。她们在两个时间点均接受了桡骨远端和胫骨的HRpQCT扫描、通过双能X线吸收法（DXA）测量的面积骨密度以及生化检测（骨特异性参数和CD血清学）。其次，我们将1年的结果与年龄和体重指数（BMI）相似的健康绝经前女性对照组的结果进行比较，以评估接受治疗的CD患者的微结构参数是否达到其年龄预期值。与基线相比，桡骨远端和胫骨的小梁部分显著改善（小梁密度、小梁/骨体积分数[BV/TV][p < 0.0001]以及小梁厚度[p = 0.0004]）。两个区域的小梁数量保持稳定。皮质密度仅在胫骨中增加（p = 0.0004）。两个部位的皮质厚度均显著降低（桡骨：p = 0.03；胫骨：p = 0.05）。所有区域的DXA均增加（腰椎[LS]，p = 0.01；股骨颈[FN]，p = 0.009；桡骨超远端[UD]，p = 0.001）。大多数参数仍显著低于健康对照组。这项前瞻性HRpQCT研究表明，大多数在CD诊断时改变的小梁参数通过特定治疗（GFD）以及补充钙和维生素D得到了显著改善。然而，与年龄和BMI相似的女性对照组仍存在显著差异。在对这组患者的前瞻性随访中，我们期望能够评估骨微结构是否达到其年龄预期水平。© 2016美国骨与矿物质研究学会。
