Wildt Signe, Munck Lars K, Becker Sabine, Brockstedt Helle, Bonderup Ole K, Hitz Mette F
a Medical Department , Zealand University Hospital Koege , Koege , Denmark.
b Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.
Postgrad Med. 2018 Apr;130(3):348-354. doi: 10.1080/00325481.2018.1441579. Epub 2018 Feb 22.
Patients with microscopic colitis (MC) have several risk factors for osteoporosis. The prevalence of osteopenia and osteoporosis in MC is unknown. The primary purpose of this study was to evaluate bone mineral status in MC.
Patients with MC and disease activity within the last 2 years were included. Bone turnover markers were analyzed and bone mineral density (BMD) was measured with Dual Energy X-ray Absorptiometry (DXA) at inclusion and after one year. Medical history, demographics, risk factors for osteoporosis, disease activity and treatment with cumulative budesonide dosage at least 3 years before inclusion was registered. Adrenal function was tested by adrenocortico-tropic hormone (ACTH) and an ACTH stimulation test at inclusion. Results were compared with age and sex-matched controls.
Fifty MC patients (44 women) were included. Median age 67 (range 45-93); median disease duration 28 month (range 2-163); median cumulative budesonide dosage 702 mg (range 0-5400). No difference in number of patients with osteoporosis or osteopenia and BMD was detected between groups. The bone mineral formation marker specific alkaline phosphatase was lower in MC than controls 12 (5-69) µg/l versus 16 (10-35) µg/l (p <0.005). Patients more often smoked (34% versus 10%, p = 0.001). Disease duration and cumulative budesonide dose was associated with lower BMD and T-score in hip (Spearman's rho; p < 0.05) with a cut of point of 2500 mg budesonide predicting osteopenia. Budesonide treatment did not affect adrenal gland function.
The risk of osteoporosis in patients with MC is not increased. However, DXA scan is recommended in MC patients with known risk factors or active disease requiring longstanding budesonide treatment. Supplementation of calcium and vitamin-D in patients treated with budesonide is recommended.
显微镜下结肠炎（MC）患者存在多种骨质疏松风险因素。MC患者中骨量减少和骨质疏松的患病率尚不清楚。本研究的主要目的是评估MC患者的骨矿物质状况。
纳入过去2年内有MC且疾病活动的患者。在纳入时和1年后分析骨转换标志物，并用双能X线吸收法（DXA）测量骨密度（BMD）。记录病史、人口统计学资料、骨质疏松风险因素、疾病活动情况以及纳入前至少3年的累积布地奈德剂量。在纳入时通过促肾上腺皮质激素（ACTH）和ACTH刺激试验检测肾上腺功能。将结果与年龄和性别匹配的对照组进行比较。
纳入50例MC患者（44例女性）。中位年龄67岁（范围45 - 93岁）；中位病程28个月（范围2 - 163个月）；中位累积布地奈德剂量702 mg（范围0 - 5400 mg）。两组间骨质疏松或骨量减少患者数量及BMD无差异。MC患者的骨矿物质形成标志物特异性碱性磷酸酶低于对照组，分别为12（5 - 69）μg/l和16（10 - 35）μg/l（p < 0.005）。患者吸烟更为频繁（34%对10%，p = 0.001）。病程和累积布地奈德剂量与髋部较低的BMD和T值相关（Spearman秩相关系数；p < 0.05），布地奈德剂量达2500 mg可预测骨量减少。布地奈德治疗不影响肾上腺功能。
MC患者骨质疏松风险未增加。然而，对于有已知风险因素或因活动性疾病需要长期布地奈德治疗的MC患者，建议进行DXA扫描。建议对接受布地奈德治疗的患者补充钙和维生素D。
