Treatment of anorexia nervosa is associated with increases in bone mineral density, and recovery is a biphasic process involving both nutrition and return of menses
Treatment of anorexia nervosa is associated with increases in bone mineral density, and recovery is a biphasic process involving both nutrition and return of menses
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DOI：
10.1093/ajcn/86.1.92
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发表时间：
2007-07-01
影响因子：
7.1
通讯作者：
Warren, Michelle P.
中科院分区：
文献类型：
--
作者：
Dominguez, Jennifer;Goodman, Linnea;Warren, Michelle P.
背景：神经性厌食症（AN）骨质疏松症的恢复是不确定的。目的：本研究旨在了解AN女性骨密度（BMD）的变化及其骨量减少的恢复机制。设计：我们研究了骨密度和骨形成和吸收的标志物，骨钙素和n -末端肽（NTX），这些患者（n = 28）遵循行为增重方案。结果：厌食症患者从入院到恢复90%理想体重，骨密度显著增加（脊柱4.38 +/- 7.48%，髋关节3.77 +/- 8.8%，均P < 0.05），时间超过2.2个月。AN患者入院时的NTX浓度分别高于健康对照组（n = 11, 69.0 +/- 31.09和48.3 +/- 14.38 nmol/mmol肌酐，P < 0.05）和参考对照组(n = 30；肌酐分别为69.0 +/- 31.09和37.0 +/- 6.00 nmol/mmol；P < 0.001)。在AN体重恢复的受试者中，骨钙素升高（从8.0 +/- 3.05到11.2 +/- 6.54 ng/mL; P < 0.05），而NTX保持升高（从69.0 +/- 31.09到66.7 +/- 45.5 nmol/mmol肌酐；NS）。NTX下降（从70.7 +/- 40.84降至45.9 +/- 22.72 nmol/mmol肌酐；NS）仅发生在体重恢复后月经恢复的受试者亚组中。结论：营养康复对骨具有强大的合成代谢作用。然而，NTX的下降和从主要吸收状态的转变，我们假设涉及到完全恢复，可能涉及激素机制，需要月经的恢复。营养康复似乎对骨恢复至关重要，这可能解释了在病毒质状态下单独使用雌激素治疗对骨密度无效的原因。
Background: Recovery from osteoporosis in anorexia nervosa (AN) is uncertain.Objective: The purpose of this study was to understand the changes in bone mineral density (BMD) in women with AN and the mechanisms of recovery from osteopenia.Design: We studied BMD and markers of bone formation and resorption, osteocalcin and N-telopeptide (NTX), in patients with AN (n = 28) who were following a behavioral weight-gain protocol.Results: Anorexic patients experienced significant percentage increases in BMD (4.38 +/- 7.48% for spine; 3.77 +/- 8.8% for hip; P < 0.05 for both) from admission until recovery of 90% ideal body weight, achieved over 2.2 mo. NTX concentrations were higher in patients with AN at admission than in healthy control subjects (n = 11; 69.0 +/- 31.09 and 48.3 +/- 14.38 nmol/mmol creatinine, respectively; P < 0.05) and in reference control subjects (n = 30; 69.0 +/- 31.09 and 37.0 +/- 6.00 nmol/mmol creatinine, respectively; P < 0.001). In weight-recovered subjects with AN, osteocalcin increased (from 8.0 +/- 3.05 to 11.2 +/- 6.54 ng/mL; P < 0.05), whereas NTX remained elevated (from 69.0 +/- 31.09 to 66.7 +/- 45.5 nmol/mmol creatinine; NS). A decrease in NTX (from 70.7 +/- 40.84 to 45.9 +/- 22.72 nmol/mmol creatinine; NS) occurred only in the subgroup of subjects who regained menses with weight recovery.Conclusions: Nutritional rehabilitation induces a powerful anabolic effect on bone. However, a fall of NTX and a shift from the dominant resorptive state, which we postulate involves full recovery, may involve a hormonal mechanism and require a return of menses. Nutritional rehabilitation appears to be critical to bone recovery and may explain the ineffectiveness of estrogen treatment alone on BMD in the cachectic state.