The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa.
The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa.
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DOI：
10.1016/s1083-3188(02)00145-6
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发表时间：
2002-06-01
影响因子：
1.8
通讯作者：
Shenker, I Ronald
中科院分区：
文献类型：
--
作者：
Golden, Neville H;Lanzkowsky, Leora;Shenker, I Ronald
前言：骨质减少是神经性厌食症（AN）的严重并发症。虽然在其他状态的雌激素缺乏，雌激素替代疗法增加骨量，其作用在AN仍然undertaking.Study目的：研究的影响，雌激素-resistin管理对骨量在AN。设计，设置，和参与者：一个前瞻性的观察性研究，50名青少年与AN（平均年龄16.8 ± 2.3岁）在三级转诊中心进行。主要观察指标：在基线和每年使用双能X线骨密度仪前瞻性测量腰椎和左髋的骨矿物质密度（BMD）。22名受试者接受雌激素-孕酮和28名单独接受标准治疗（Rx）。每日给予雌激素-炔雌醇作为含20-35 mcg炔雌醇的口服避孕药。所有受试者均接受钙补充剂和相同的医疗、心理和营养干预（标准处方）。平均随访时间为23.1 +/- 11.4 months.Results：在就诊时，患者营养不良（79.5% +/-7.6%IBW），低雌激素血症（雌二醇24.7 +/- 10.7 pg/mL），骨量减少（腰椎BMD -2.01 +/- 0.69 SD低于年轻成人参考均值）。92%的受试者患有骨质疏松症，26%符合世界卫生组织骨质疏松症标准。体重（无治疗组）是骨密度的主要决定因素。在一年的随访中，接受雌激素-炔雌醇的患者和接受标准Rx的患者之间腰椎或股骨颈BMD的绝对值或净变化没有显著差异（80%的把握度发现1年时BMD差异为3%）。在那些随后的2-3 yrs，骨量减少是持久的，在某些情况下progressives.CONCLUSION：在我们的研究人群中，雌激素-孕激素并没有显着增加BMD相比，标准的Rx。这些结果质疑了在AN中使用激素替代疗法来增加骨量的常见做法。
INTRODUCTION: Osteopenia is a serious complication of anorexia nervosa (AN). Although in other states of estrogen deficiency, estrogen replacement therapy increases bone mass, its role in AN remains unresolved.STUDY OBJECTIVE: To study the effect of estrogen-progestin administration on bone mass in AN.DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study of 50 adolescents with AN (mean age 16.8 +/- 2.3 yrs) was conducted in a tertiary referral center.MAIN OUTCOME MEASURES: Bone mineral density (BMD) of the lumbar spine and left hip were prospectively measured using dual-energy x-ray absorptiometry at baseline and annually.INTERVENTIONS: Twenty-two subjects received estrogen-progestin and 28 standard treatment (Rx) alone. Estrogen-progestin was administered daily as an oral contraceptive containing 20-35 mcg ethinyl estradiol. All subjects received calcium supplementation and the same medical, psychological, and nutritional intervention (standard Rx). Mean length of follow-up was 23.1 +/- 11.4 months.RESULTS: At presentation, patients were malnourished (79.5% +/- 7.6% IBW), hypoestrogenemic (estradiol 24.7 +/- 10.7 pg/mL), and had reduced bone mass (lumbar spine BMD -2.01 +/- 0.69 SD below the young adult reference mean). Ninety-two percent of subjects were osteopenic and 26% met WHO criteria for osteoporosis. Body weight, and no treatment group, was the major determinant of BMD. At one-year follow-up, there were no significant differences in absolute values or in net change of lumbar spine or femoral neck BMD between those who received estrogen-progestin and those who received standard Rx (80% power of finding a 3% difference in BMD at 1 yr). In those followed for 2-3 yrs, osteopenia was persistent and in some cases progressive.CONCLUSION: In our study population, estrogen-progestin did not significantly increase BMD compared with standard Rx. These results question the common practice of prescribing hormone replacement therapy to increase bone mass in AN.