Corazza G R, Di Sario A, Cecchetti L, Tarozzi C, Corrao G, Bernardi M, Gasbarrini G
Department of Internal Medicine, University of L'Aquila, Italy.
Gastroenterology. 1995 Jul;109(1):122-8. doi: 10.1016/0016-5085(95)90276-7.
BACKGROUND & AIMS: Several aspects of the pathogenesis of osteopenia in celiac disease are still unclear. Therefore, bone mass and metabolism were evaluated in adults with celiac disease in a cross-sectional study.
Bone mineral density (BMD), assessed by total body dual-photon absorptiometry, and serum indices of bone metabolism and remodeling were evaluated in 17 patients with untreated celiac disease, 14 with celiac disease on a gluten-free diet, and 24 healthy volunteers.
BMD, expressed as a z score, was significantly lower in patients with untreated celiac disease than in patients with treated celiac disease and volunteers and lower in patients with treated celiac disease than in volunteers. Similar changes were observed in serum calcium level, whereas intact parathyroid hormone level was significantly higher in untreated than in treated patients with celiac disease and volunteers, and no difference was found between the latter two groups. 25-Vitamin D level was significantly lower and 1,25-vitamin D level significantly higher in untreated celiac disease than in treated celiac disease and volunteers. Indices of bone remodeling were significantly higher in untreated than in treated patients and volunteers and significantly and positively correlated with iPTH in untreated patients with celiac disease.
BMD is almost invariably low in patients with untreated celiac disease. Results in treated patients suggest that gluten-free diet improves but does not normalize BMD. Untreated celiac disease is characterized by high levels of 1,25-vitamin D and by increased bone turnover, caused by the increase in intact parathyroid hormone level.
乳糜泻中骨质减少的发病机制的几个方面仍不清楚。因此，在一项横断面研究中对成年乳糜泻患者的骨量和代谢进行了评估。
通过全身双能光子吸收法评估骨矿物质密度（BMD），并对17例未经治疗的乳糜泻患者、14例采用无麸质饮食的乳糜泻患者和24名健康志愿者的骨代谢和重塑血清指标进行了评估。
以z值表示的BMD在未经治疗的乳糜泻患者中显著低于接受治疗的乳糜泻患者和志愿者，在接受治疗的乳糜泻患者中低于志愿者。血清钙水平也有类似变化，而未治疗的乳糜泻患者的完整甲状旁腺激素水平显著高于接受治疗的患者和志愿者，后两组之间未发现差异。未经治疗的乳糜泻患者的25-维生素D水平显著低于接受治疗的乳糜泻患者和志愿者，而1,25-维生素D水平显著高于后者。未治疗患者的骨重塑指标显著高于接受治疗的患者和志愿者，且与未治疗的乳糜泻患者的iPTH显著正相关。
未经治疗的乳糜泻患者的BMD几乎总是较低。接受治疗的患者的结果表明，无麸质饮食可改善但不能使BMD恢复正常。未经治疗的乳糜泻的特征是1,25-维生素D水平高以及由于完整甲状旁腺激素水平升高导致的骨转换增加。
