Department of Gastroenterology and Hepatology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands.
Department of Rheumatology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands.
Nutrients. 2022 Oct 28;14(21):4554. doi: 10.3390/nu14214554.
Impaired bone mineral density (BMD) is a frequent complication of adult-onset celiac disease (CeD). This is usually due to malabsorption of nutrients, changes in bone metabolism in association with inflammation, and to a lesser extent, decreased overall physical health and mobility. This review aims to highlight the current status concerning surveillance, prevention, and treatment strategies for bone disease in CeD. A practical guidance on these matters is suggested. The available published research on the prevention and treatment of decreased BMD in relation to CeD is scarce. In general, publications were based on expert opinions or extrapolation from studies on postmenopausal women or inflammatory bowel disease. Optimal dietary treatment and an adequate supply of calcium and vitamin D are the cornerstones for the reduction in fracture risk in patients with CeD. In adults with low BMD or fragility fractures, CeD needs to be considered and specifically approached. When osteoporosis is documented, start treatment with an antiresorptive agent; these agents are proven to result in a long-term reduction in fracture risk in high-risk individuals. However, there are some important differences between the management of male and female patients, particularly premenopausal women, that need to be addressed. In patients with persisting diarrhea and malabsorption, parenteral medications may be preferable. Future research specifically focusing on celiac disease and the associated disorders in bone mineralization is mandatory to provide evidence-based recommendations in this field.
骨密度降低（BMD）是成人发病乳糜泻（CeD）的常见并发症。这通常是由于营养吸收不良、与炎症相关的骨代谢变化，以及在较小程度上，整体身体健康和活动能力下降所致。本文旨在强调 CeD 患者骨骼疾病的监测、预防和治疗策略的现状。提出了这些问题的实用指导。关于 CeD 与 BMD 降低相关的预防和治疗的现有研究很少。一般来说，这些出版物基于专家意见或从绝经后妇女或炎症性肠病研究中的推断。最佳的饮食治疗和钙及维生素 D 的充足供应是降低 CeD 患者骨折风险的基石。对于低 BMD 或脆性骨折的成年人，需要考虑并专门针对 CeD 进行治疗。当骨质疏松症得到证实时，开始使用抗吸收剂治疗；这些药物已被证明可降低高风险人群的骨折风险。然而，男性和女性患者之间存在一些重要的差异，特别是绝经前妇女，需要加以解决。对于持续腹泻和吸收不良的患者，可能更适合使用肠外药物。未来专门针对乳糜泻和相关骨矿化紊乱的研究对于在该领域提供循证建议是必要的。
