Walker Marcella D, Williams John, Lewis Suzanne K, Bai Julio C, Lebwohl Benjamin, Green Peter H R
Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, New York.
Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, New York.
Clin Gastroenterol Hepatol. 2020 Jan;18(1):99-106. doi: 10.1016/j.cgh.2019.03.049. Epub 2019 Apr 10.
BACKGROUND & AIMS: Guidelines advise measurement of bone mineral density (BMD) in patients with a diagnosis of celiac disease. The lumbar spine (LS) and hip sites are usually measured. Although skeletal sites rich in trabecular bone are believed to be vulnerable to osteoporosis in patients with celiac disease, most studies have not measured the cortical distal 1/3-radius.
We collected data from 721 patients (mean age, 43.6 years; 68.4% female) with celiac disease who underwent 3-site dual energy x-ray absorptiometry (DXA, at a median 1.22 years after diagnosis). We assessed skeletal site- and sex-specific osteoporosis prevalence and the incremental utility of 1/3-radius measurement by DXA.
Mean T- and Z-scores were normal in patients, but 43.3% had osteopenia and 19.6% had osteoporosis. Osteoporosis was found in 12.1% of patients at the LS, 5.3% of patients at the total hip, 7.6% of patients at the femoral neck, and 11.5% of patients at the 1/3-radius. A greater degree of villous atrophy at diagnosis was associated with male sex and lower T-scores at the 1/3-radius (P = .03), but not other skeletal sites. Isolated forearm osteoporosis was detected in 4.9% of patients. A higher proportion of patients with isolated forearm osteoporosis were male and had a greater weight and body mass index (all P < .01, compared to patients with osteoporosis only at other sites). Z-scores were lower at the LS and 1/3-radius and osteoporosis was more common in men than women. In men, the 1/3-radius was the most frequent site for osteoporosis. Among patients 50 years or older, isolated forearm osteoporosis was present in 10.7%.
Based on DXA analysis of patients with celiac disease, the prevalence of osteoporosis appears to be underestimated-particularly in men when BMD at the 1/3-radius is not measured. Degree of villous atrophy is associated with BMD at the 1/3-radius and nearly 5% of patients have osteoporosis limited to that site. Recommendations for osteoporosis screening in patients with celiac disease should include measurement of the distal 1/3-radius in addition to the hip and LS.
指南建议对确诊为乳糜泻的患者进行骨密度（BMD）测量。通常测量腰椎（LS）和髋部。尽管富含小梁骨的骨骼部位被认为在乳糜泻患者中易患骨质疏松症，但大多数研究并未测量皮质骨远端1/3半径处。
我们收集了721例乳糜泻患者（平均年龄43.6岁；68.4%为女性）的数据，这些患者在诊断后中位时间1.22年接受了三点双能X线吸收法（DXA）检查。我们评估了特定骨骼部位和性别的骨质疏松症患病率以及DXA测量1/3半径处的增量效用。
患者的平均T值和Z值正常，但43.3%的患者有骨量减少，19.6%的患者有骨质疏松症。在LS处，12.1%的患者有骨质疏松症；在全髋处，5.3%的患者有骨质疏松症；在股骨颈处，7.6%的患者有骨质疏松症；在1/3半径处，11.5%的患者有骨质疏松症。诊断时绒毛萎缩程度较高与男性性别以及1/3半径处较低的T值相关（P = 0.03），但与其他骨骼部位无关。4.9%的患者检测到孤立性前臂骨质疏松症。与仅在其他部位有骨质疏松症的患者相比，孤立性前臂骨质疏松症患者中男性比例更高，体重和体重指数更大（所有P < 0.01）。LS和1/3半径处的Z值较低，男性骨质疏松症比女性更常见。在男性中，1/3半径处是最常见的骨质疏松症部位。在50岁及以上的患者中，10.7%有孤立性前臂骨质疏松症。
基于对乳糜泻患者的DXA分析，骨质疏松症的患病率似乎被低估了——尤其是在未测量1/3半径处骨密度的男性中。绒毛萎缩程度与1/3半径处的骨密度相关，近5%的患者骨质疏松症仅限于该部位。对乳糜泻患者进行骨质疏松症筛查的建议应包括除髋部和LS外，测量远端1/3半径处。
