Evaluation of Bone Loss and Its Mechanisms in Anorexia Nervosa
Evaluation of Bone Loss and Its Mechanisms in Anorexia Nervosa
复制标题
神经性厌食症的骨丢失及其机制的评估
DOI：
--
复制
发表时间：
2007
影响因子：
4.2
通讯作者：
B. Cortet
中科院分区：
文献类型：
--
作者：
I. Legroux;J. Vignau;M. D'herbomez;F. Collier;X. Marchandise;B. Duquesnoy;B. Cortet
这项横断面研究的目的是评估神经性厌食症患者骨质流失的程度和机制。我们将 113 名神经性厌食症患者（平均年龄 25 ± 8 岁，平均病程 5.7 ± 6.1 年）与 21 名年龄匹配的对照组进行了比较。闭经的平均持续时间为 3.2 ± 4.7 年。我们测量了血清钙和磷酸盐；骨重塑标志物（骨钙素、骨特异性碱性磷酸酶 [BSAP]、血清 crosslaps [CTX] 和 I 型胶原羧基末端端肽 [ICTP]）；卵泡刺激素和黄体生成素水平；雌二醇（超灵敏测定）、皮质醇、尿游离皮质醇、甲状腺功能、催乳素和营养因子（胰岛素样生长因子 I [IGF-I]、IGF 结合蛋白 3 [IGFBP3]）。在对照组中，仅测量骨重塑标志物和营养因素。还对患者和对照进行骨密度测定。神经性厌食症患者的体重和体重指数 (BMI) 显着低于对照组 (P < 0.0001)。除IGF-I外，其他生物指标均无显着差异，神经性厌食症患者的IGF-I（0.9±0.4 UI/mL）低于对照组（1.5±0.4 UI/mL）（P < 0.0001）。神经性厌食症患者三个部位的光密度测量值显着较低，并且与疾病持续时间和闭经以及仅与臀部的 IGF-I 相关（P < 0.01）。在研究人群中，24 名患者（21%）出现骨质疏松症，54 名患者（48%）出现骨质减少。骨质疏松症患者年龄明显较大，患病时间和闭经持续时间较长；体重和体重指数较低；较高碱性磷酸酶、BSAP 和骨钙素；并降低血清 ICTP、IGF-I 和 IGFBP3。除 IGF-I 外（P = 0.21），所有这些差异都很显着，并且即使在进行多次调整后仍然如此。当进行多变量分析时，我们发现闭经发病年龄、体重、碱性磷酸酶、尿游离皮质醇和血清雌二醇浓度占脊柱骨矿物质密度（BMD）方差的 54%。闭经持续时间、碱性磷酸酶和体重解释了股骨颈 BMD 差异的 46.6%。闭经持续时间、IGF-I 和 ICTP 水平占髋部总 BMD 观察到的方差的 38.6%。神经性厌食症患者骨质流失的病因是多因素的。仅雌激素水平低下并不能解释这种损失，营养因素，特别是 IGF-I 浓度，似乎发挥着重要作用。
The purpose of this cross-sectional study was to assess the extent of and mechanisms involved in bone loss in anorexia nervosa patients. We compared 113 anorexia nervosa patients (mean age 25 ± 8 years, mean duration of disease 5.7 ± 6.1 years) with 21 age-matched controls. Mean duration of amenorrhea was 3.2 ± 4.7 years. We measured serum calcium and phosphate; bone remodeling markers (osteocalcin, bone-specific alkaline phosphatase [BSAP], serum crosslaps [CTX], and carboxyl-terminal telopeptide of type I collagen [ICTP]); follicle-stimulating hormone and luteinizing hormone levels; and estradiol (ultrasensitive assay), cortisol, urinary free cortisol, thyroid function, prolactin, and nutritional factors (insulin-like growth factor I [IGF-I], IGF binding protein 3 [IGFBP3]). In controls, only bone remodeling markers and nutritional factors were measured. Osteodensitometry was also performed on both patients and controls. Weight and body mass index (BMI) were significantly lower in anorexia nervosa patients than in controls (P < 0.0001). No significant differences were observed in biological indicators except for IGF-I, which was lower in anorexia nervosa patients (0.9 ± 0.4 UI/mL) than in controls (1.5 ± 0.4 UI/mL) (P < 0.0001). Densitometric measurements at three sites were significantly lower in anorexia nervosa patients and correlated with duration of disease and amenorrhea and with IGF-I at the hip only (P < 0.01). In the study population, osteoporosis was observed in 24 patients (21%) and osteopenia in 54 patients (48%). Patients with osteoporosis were significantly older and had longer disease and amenorrhea durations; lower weight and BMI; higher alkaline phosphatase, BSAP, and osteocalcin; and lower serum ICTP, IGF-I, and IGFBP3. All of these differences were significant and remained so even after multiple adjustments were made, except for IGF-I (P = 0.21). When multivariate analysis was performed, we found that age at onset of amenorrhea, weight, alkaline phosphatase, urinary free cortisol, and serum estradiol concentration accounted for 54% of the variance in spinal bone mineral density (BMD). Duration of amenorrhea, alkaline phosphatase, and weight explained 46.6% of the variance in femoral neck BMD. Duration of amenorrhea, IGF-I, and ICTP levels accounted for 38.6% of the variance observed in total hip BMD. The etiology of bone loss in patients with anorexia nervosa is multifactorial. Hypoestrogenia alone cannot account for this loss, and nutritional factors, IGF-I concentrations in particular, seem to play an important role.
登录
查看更多内容
15 至 21 岁月经正常和闭经受试者的骨矿物质密度。
DOI：
10.1001/archpedi.1992.02160130033016
发表时间：
1992
期刊：
American journal of diseases of children (1960)
影响因子：
--
作者：
White,CM;Hergenroeder,AC;Klish,WJ
通讯作者：
Klish,WJ
雌激素给药对神经性厌食症年轻女性骨小梁丢失的影响。
DOI：
10.1210/jcem.80.3.7883849
发表时间：
1995
期刊：
The Journal of clinical endocrinology and metabolism.
影响因子：
--
作者：
Klibanski,A;Biller,BM;Schoenfeld,DA;Herzog,DB;Saxe,VC
通讯作者：
Saxe,VC
患有神经性厌食症和下丘脑闭经的雌激素缺乏女性骨质减少的严重程度。
DOI：
10.1210/jcem.84.6.5792
发表时间：
1999
期刊：
The Journal of clinical endocrinology and metabolism.
影响因子：
--
作者：
Grinspoon,S;Miller,K;Coyle,C;Krempin,J;Armstrong,C;Pitts,S;Herzog,D;Klibanski,A
通讯作者：
Klibanski,A
患有神经性厌食症的青春期女孩骨密度下降。
影响因子：
8
作者：
Bachrach,LK;Guido,D;Katzman,D;Litt,IF;Marcus,R
通讯作者：
Marcus,R