RECOVERY FROM OSTEOPENIA IN ADOLESCENT GIRLS WITH ANOREXIA-NERVOSA
RECOVERY FROM OSTEOPENIA IN ADOLESCENT GIRLS WITH ANOREXIA-NERVOSA
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DOI：
10.1210/jcem-72-3-602
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发表时间：
1991-03-01
影响因子：
5.8
通讯作者：
MARCUS, R
中科院分区：
文献类型：
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作者：
BACHRACH, LK;KATZMAN, DK;MARCUS, R
骨量减少是神经性厌食症(AN)的常见并发症。为了确定骨矿物质缺乏在疾病过程中是否发生变化，我们对15名青少年患者进行了12-16个月的前瞻性研究，采用脊柱和全身双光子吸收法。在随访中，平均体重、身高和身体质量指数(BMI)显著增加，尽管有6名女孩体重进一步减轻或仅有轻微增加(<；1.2公斤)。2名女孩出现自然月经，另外3名接受雌激素替代治疗。腰椎骨密度无明显变化(平均+/-SD，0.836+/-0.137比0.855+/-0.096 g/cm~2)，而全身骨密度增加(0.710+/-0.118比0.773+/-0.105；P<；0.05)。尽管骨矿物质有所增加，但有8名患者脊柱和/或全身骨量减少。体重、身高和BMI的变化是骨密度变化的重要预测因子。随着月经恢复前体重增加，骨量增加；相反，体重减轻与骨密度进一步下降有关。在1名体重未能增加的患者中，雌激素治疗导致脊柱骨矿物质增加，但不是全身骨矿物质增加。我们还研究了第二组9名从青春期肺炎中恢复过来的女性。所有9人的全身骨矿含量随年龄增长正常，但3人腰椎骨量减少。我们的结论是，青少年AN患者的骨量减少反映了骨丢失，可能合并骨吸收减少。体重康复会导致月经恢复前骨矿物质的增加。雌激素可能对骨量有独立的影响。恢复后持续的骨量减少表明，青春期获得的骨矿物质缺乏可能不是完全可逆的。
Osteopenia is a frequent complication of anorexia nervosa (AN). To determine whether the deficit in bone mineral changes during the course of this illness, we studied 15 adolescent patients prospectively for 12-16 months using dual photon absorptiometry of the spine and whole body. At follow-up, mean weight, height, and body mass index (BMI) had increased significantly, although 6 girls had further weight loss or minimal gain ( < 1.2 kg). Spontaneous menses occurred in 2 girls, and 3 others were given estrogen replacement. Bone mineral density of the lumbar spine did not change significantly (mean +/- SD, 0.836 +/- 0.137 vs. 0.855 +/- 0.096 g/cm2), while whole body bone mineral density increased (0.710 +/- 0.118 vs. 0.773 +/- 0.105; P < 0.05). Despite gains in bone mineral, 8 patients had osteopenia of the spine and/or whole body. Changes in weight, height, and BMI were significant predictors of change in bone mineral density. Increased bone mass occurred with weight gain before return of menses; conversely, weight loss was associated with further decreases in bone density. In 1 patient who failed to gain weight, estrogen therapy resulted in increased spinal, but not whole body, bone mineral. We also studied a second group of 9 women who had recovered from AN during adolescence. All 9 had normal whole body bone mineral for age, but 3 had osteopenia of the lumbar spine.We conclude that osteopenia in adolescents with AN reflects bone loss, perhaps combined with decreased bone accretion. Weight rehabilitation results in increased bone mineral before the return of menses. Estrogen may have an independent effect on bone mass. The persistence of osteopenia after recovery indicates that deficits in bone mineral acquired during adolescence may not be completely reversible.