A prospective study of changes in bone turnover and bone density associated with regaining weight in women with anorexia nervosa
A prospective study of changes in bone turnover and bone density associated with regaining weight in women with anorexia nervosa
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DOI：
10.1007/s00198-005-1972-7
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发表时间：
2005-12-01
影响因子：
4
通讯作者：
White, S
中科院分区：
文献类型：
--
作者：
Bolton, JGF;Patel, S;White, S
神经性厌食症（AN）是一种自我诱导的体重减轻的状况，与对体重增加的强烈恐惧有关。以前的研究表明，骨密度可能会随着恢复和维持正常体重而增加;然而，对体重恢复期间发生的骨代谢变化知之甚少。我们描述了体重恢复和维持体重超过1年对骨密度（BMD）和骨转换的影响。我们从伦敦西南部和乔治精神健康NHS信托基金以及英国伦敦的Priory和Charter Nightingale医院的饮食失调服务中招募了女性。通过访谈和病例回顾获得他们的AN、骨折史、月经史和运动的详细信息。采集早晨血液和第二次尿液样本进行生化分析。用DXA测量腰椎（LS）、股骨颈（FN）、桡骨远端（RD）的BMD和全身骨矿含量（BMC）。然后，患者进入治疗计划，其中包括重新喂养，饮食教育和心理治疗。在42个月的时间里，我们招募了55名同意参加这项研究的妇女，并进行了基线调查。其中，15例（27%）受试者达到目标体重，然后在研究期间保持目标体重。在基线时，所有受试者（n =55）中91%的女性雌二醇水平低于正常参考范围（卵泡期和黄体期）。55%的女性骨特异性碱性磷酸酶（BSAP）浓度低于绝经前参考范围，78%的女性尿脱氧吡啶啉（DPD）高于绝经前参考范围。基线腰椎BMD与BMI呈正相关（Pearson r =0.29，P =0.04），与骨转换标志物呈负相关：尿DPD（Pearson r =-0.39，P =0.01）和血清BSAP（Pearson r =-0.3，P =0.06）。15例体重恢复并保持体重的患者平均随访69周（SD 7.3，范围54 - 84周）。平均BMI从14.2（1.7）增加到20.2（0.77）kg/m2，并在整个随访期间保持稳定。15例中8例恢复月经。全身BMC和LS BMD在随访期间显著增加（各增加4.3%），但FN BMD和桡骨远端保持稳定。腰椎骨面积也显著增加，而FN和桡骨远端没有。这些变化与BSAP显著增加（P =0.01）和DPD降低的非显著趋势（P =0.10）相关。我们的研究结果表明，当女性处于低体重时，她们处于低雌激素状态，这与骨转换失衡（高骨吸收和低骨形成）有关。这与体重增加相反，并随着目标体重的维持而持续，并与BMC和BMD的增加相关。
Anorexia nervosa (AN) is a condition of self-induced weight loss, associated with an intense fear of gaining weight. Previous studies have shown that bone density may increase with regaining and maintaining normal weight; however, relatively little is known about the changes in bone metabolism that occur during weight restoration. We describe the effect of weight restoration and maintenance of weight over 1 year on bone mineral density (BMD) and bone turnover. We recruited women from the eating disorders services at the South West London and St George's Mental Health NHS Trust, and the Priory and Charter Nightingale Hospitals in London, UK. Details of their AN, fracture history, menstrual history and exercise were obtained by interview and case note review. Morning samples of blood and second void urine were taken for biochemical analysis. BMD was measured by DXA at the lumbar spine (LS), femoral neck (FN), distal radius (RD) and total body bone mineral content (BMC). Patients then entered the treatment program, which includes re-feeding, dietary education and psychotherapy. Over a period of 42 months, we recruited 55 women who agreed to participate in this study and underwent baseline investigations. Of these, 15 (27%) subjects achieved and then maintained their target weight for the duration of the study. At baseline for all subjects ( n =55) estradiol levels were lower than the normal reference ranges (both follicular and luteal phases) in 91% of the women. Bone specific alkaline phosphatase (BSAP) concentrations were lower than the premenopausal reference range in 55% of women, and urinary deoxypyridinoline (DPD) was above the premenopausal reference range in 78% of women. Baseline lumbar spine BMD was positively related to BMI (Pearson's r =0.29, P =0.04) and inversely related to bone turnover markers: urinary DPD (Pearson's r =-0.39, P =0.01 and serum BSAP (Pearson's r =-0.3, P =0.06). The 15 patients who regained and maintained weight were followed-up for a mean duration of 69 weeks (SD 7.3, range 54 to 84 weeks). Mean BMI increased from 14.2 (1.7) to 20.2 (0.77) kg/m(2) and remained stable throughout follow-up. Menstruation resumed in 8 of the 15 women. Total body BMC and LS BMD increased significantly over the duration of follow-up (by 4.3% each), but FN BMD and distal radius remained stable. Lumbar spine bone area also increased significantly, whereas FN and distal radius did not. These changes were associated with a significant increase in BSAP ( P =0.01), and a non-significant trend for a decrease in DPD ( P =0.10). Our findings suggest that when women are at low body weight they are in a hypo-estrogenic state, which is associated with imbalance of bone turnover (high bone resorption and low bone formation). This is reversed with weight gain and persists as target weight is maintained and is associated with increases in BMC and BMD.