Mazure R, Vazquez H, Gonzalez D, Mautalen C, Pedreira S, Boerr L, Bai J C
Small Bowel Section, Gastroenterology Hospital, Buenos Aires, Argentina.
Am J Gastroenterol. 1994 Dec;89(12):2130-4.
Osteopenia is a well-known complication of overt celiac disease, but whether such defective bone mineralization is present among asymptomatic or silent patients is not known. Our objectives were: 1) to examine bone mineralization of a group of asymptomatic celiac patients; 2) to compare these results with those of symptomatic patients.
Bone mineral density of the spine and total skeleton by dual energy x-ray absorptiometry and serum parameters of mineral metabolism of eight recently diagnosed asymptomatic patients with celiac disease were studied. Results were compared with those obtained in 20 untreated symptomatic celiacs, 14 patients treated with gluten-free diet for a mean time of 15 yr, and 153 healthy adult subjects, matched by sex and age.
Four and five out of eight asymptomatic patients presented with reduced mineralization of the spine and the total skeleton, respectively (> 1 SD below normal values for sex and age). Two patients presented with severe osteopenia of the spine, and the other three presented with severe osteopenia of the whole skeleton (> 2 SD below mean normal values). Osteopenia at plane bone level (total skeleton) was significantly lower when compared to healthy controls (p < 0.02). Symptomatic untreated patients had significantly more severe deterioration of bone mineralization than did asymptomatics (p < 0.05) and treated patients (p < 0.05). No difference in bone mineral density was observed between treated patients and asymptomatic celiacs. Serum levels of calcium, alkaline phosphatase, 25-OH vitamin D, and parathormone did not show conclusive abnormalities.
Our findings provide direct evidence that reduced bone mineralization occurs in asymptomatic celiac patients before any other symptom becomes evident. Only early diagnosis and treatment of celiac disease can avoid the deterioration of the bone structure observed in all clinical status of celiac disease.
骨质减少是显性乳糜泻的一种常见并发症，但无症状或隐匿性患者是否存在这种骨矿化缺陷尚不清楚。我们的目的是：1）检查一组无症状乳糜泻患者的骨矿化情况；2）将这些结果与有症状患者的结果进行比较。
研究了8例近期诊断出的无症状乳糜泻患者的脊柱和全身骨骼的骨密度以及矿物质代谢的血清参数。将结果与20例未经治疗的有症状乳糜泻患者、14例平均接受无麸质饮食治疗15年的患者以及153名按性别和年龄匹配的健康成年人的结果进行比较。
8例无症状患者中，分别有4例和5例出现脊柱和全身骨骼矿化减少（比性别和年龄的正常值低>1个标准差）。2例患者出现严重的脊柱骨质减少，另外3例出现严重的全身骨骼骨质减少（比正常平均值低>2个标准差）。与健康对照组相比，扁平骨水平（全身骨骼）的骨质减少明显更低（p<0.02）。有症状的未经治疗的患者的骨矿化恶化程度明显比无症状患者（p<0.05）和接受治疗的患者（p<0.05）更严重。在接受治疗的患者和无症状乳糜泻患者之间未观察到骨密度差异。血清钙、碱性磷酸酶、25-羟基维生素D和甲状旁腺激素水平未显示出明确的异常。
我们的研究结果提供了直接证据，表明在无症状乳糜泻患者出现任何其他症状之前就已发生骨矿化减少。只有乳糜泻的早期诊断和治疗才能避免在乳糜泻所有临床状态中观察到的骨结构恶化。
