Normalization of bone density in a previously amenorrheic runner with osteoporosis
Normalization of bone density in a previously amenorrheic runner with osteoporosis
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DOI：
10.1249/01.mss.0000177561.95201.8f
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发表时间：
2005-09-01
期刊：
影响因子：
--
通讯作者：
Kent, K
中科院分区：
文献类型：
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作者：
Fredericson, M;Kent, K
目的：研究一名被诊断为进食障碍、闭经和骨质疏松症三联征的长跑运动员的骨密度（BMD）和骨矿物质含量（BMC）变化与药物和营养干预的关系。方法：采用双能X线骨密度仪（DXA）测量22.9 ~ 30.8岁腰椎（L2 ~ L4）和股骨近端的骨密度。结果：患者22.9岁时，表现为原发性闭经、低体重（BMI：15.8 kg（.）m（-2）），脊柱（正常值的74%，T评分：-2.50）和髋部（正常值的80%，T评分：-1.54）BMD较低。在接下来的2年里，患者服用口服避孕药以诱导月经，但继续保持低体重。BMD保持不变。在25.1岁时，她决定增加体重并改善营养，导致4个月内脊柱BMD（+1.1%）、髋关节BMD（+1.6%）和全身BMC（+7.6%）小幅增加。从25.4岁到30.8岁，患者体重持续增加，最终达到21.3 kg的健康BMI。m（-2）;相应地，从基线开始，她的脊柱BMD增加了25.5%，髋部增加了19.5%，使她的BMD在正常值范围内（脊柱：正常值的94%，髋部：正常值的96%）。结论：该病例说明，即使骨骼发育在青春期中断，骨密度在生命的第三个十年中仍然有“追赶”的潜力。本例患者骨密度缺损的恢复可归因于营养改善和体重增加，但与激素替代无关。
Purpose: To examine changes in bone mineral density (BMD) and bone mineral content (BMC) in relation to pharmacological and nutritional interventions in a distance runner diagnosed with the female athlete triad of disordered eating, amenorrhea, and osteoporosis. Methods: BMD of the lumbar spine (L2-L4) and total proximal femur were measured from ages 22.9 to 30.8 yr using dual x-ray absorptiometry (DXA). Results: At age 22.9, the patient presented with primary amenorrhea, low body weight (BMI: 15.8 kg(.)m(-2)), and low BMD in the spine (74% of normal, T score: -2.50) and hip (80% of normal, T score: -1.54). For the next 2 yr, the patient took oral contraceptives to induce menses, but continued to maintain a low weight. Her BMD remained unchanged. At age 25.1 yr, she decided to gain weight and improve her nutrition, resulting in small increases in spinal BMD(+ 1.1%), hip BMD (+1.6%), and total body BMC (+7.6%) in 4 months. From ages 25.4 to 30.8 yr, the patient continued to gain weight, eventually reaching a healthy BMI of 21.3 kg(.)m(-2); correspondingly, since baseline, her BMD had increased 25.5% in the spine and 19.5% in the hip, bringing her BMD to within normal values (spine: 94% of normal, hip: 96% of normal). Conclusion: This case illustrates that even if skeletal development is interrupted in adolescence, there is still the potential for "catch-up" in BMD well into the third decade of life. Reversal of large bone density deficits in this patient can be attributed to improved nutrition and weight gain but not to hormone replacement.