Mautalen C, González D, Mazure R, Vázquez H, Lorenzetti M P, Maurino E, Niveloni S, Pedreira S, Smecuol E, Boerr L A, Bai J C
Clinical Department, Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Salvador University, Buenos Aires, Argentina.
Am J Gastroenterol. 1997 Feb;92(2):313-8.
BACKGROUND/AIMS: Osteopenia is a common complication of celiac disease. The aims of this study were to evaluate whether treatment produces bone remineralization and whether calcium and vitamin D supplementation are necessary to reduce osteopenia.
Bone mineral density and biochemical parameters of bone and mineral metabolism were measured in 14 newly diagnosed adult celiac disease patients. All patients were treated with a gluten-free diet and were randomized to receive diet only (n = 7) or diet plus calcium (1.0 g/day) and vitamin D (32,000 IU/wk) supplementation (n = 7). Bone density was measured at baseline and at 6 and 12 months of follow-up. Tests for biochemical determinations were repeated every 3 months.
At diagnosis, 11 patients had evidence of osteopenia (> 1 SD below normality) in the spine and total skeleton. After 12 months of gluten restriction, overall bone mass had increased 5.0% (p < 0.01) in the lumbar spine and 5.0% (p < 0.002) in the total skeleton. When one only considers those 11 patients who strictly followed gluten restriction, bone density increased 8.4% in the lumbar spine and 7.7% in the total skeleton. Remineralization occurred throughout the skeleton but was more pronounced in the axial than in the peripheral skeleton. The increase in bone mass was independent of age or menopause. Remineralization in patients treated with diet only was similar to that of patients treated with diet and supplements. Basal biochemical parameters showed a high bone turnover with secondary hyperparathyroidism. Treatment induced a decrease in bone turnover activity. However, a complete restoration of biochemical parameters was not achieved.
Strict gluten avoidance promoted a significant increase in bone mineral density. However, values still remain markedly low after 1 yr in several patients. Although calcium and vitamin D supplementation did not provide additional benefit to that obtained by diet alone in the doses administered, our results do not preclude a possible effect of vitamin D at higher dose.
背景/目的：骨质减少是乳糜泻的常见并发症。本研究的目的是评估治疗是否能使骨骼再矿化，以及补充钙和维生素D对于减轻骨质减少是否必要。
对14例新诊断的成年乳糜泻患者测量骨密度以及骨和矿物质代谢的生化指标。所有患者均接受无麸质饮食治疗，并随机分为仅接受饮食治疗组（n = 7）或饮食加钙（1.0克/天）和维生素D（32,000国际单位/周）补充剂组（n = 7）。在基线以及随访的6个月和12个月时测量骨密度。每3个月重复进行生化测定。
诊断时，11例患者在脊柱和全身骨骼有骨质减少的证据（低于正常1个标准差以上）。在限制麸质饮食12个月后，腰椎的总体骨量增加了5.0%（p < 0.01），全身骨骼增加了5.0%（p < 0.002）。仅考虑严格遵循麸质限制的11例患者时，腰椎骨密度增加了8.4%，全身骨骼增加了7.7%。再矿化发生在整个骨骼，但在中轴骨骼比外周骨骼更明显。骨量增加与年龄或绝经无关。仅接受饮食治疗的患者与接受饮食加补充剂治疗的患者的再矿化情况相似。基础生化指标显示骨转换率高伴继发性甲状旁腺功能亢进。治疗使骨转换活性降低。然而，生化指标并未完全恢复。
严格避免麸质可显著提高骨密度。然而，1年后仍有若干患者的值明显偏低。尽管在给予的剂量下，补充钙和维生素D并未比单独饮食带来额外益处，但我们的结果并不排除更高剂量维生素D可能产生的作用。
