Changes in bone mineral density, body composition and biochemical markers of bone turnover during weight gain in adolescents with severe anorexia nervosa: a 1-year prospective study
Changes in bone mineral density, body composition and biochemical markers of bone turnover during weight gain in adolescents with severe anorexia nervosa: a 1-year prospective study
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DOI：
10.1007/s00198-005-1904-6
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发表时间：
2006-01-01
影响因子：
4
通讯作者：
Jaffa, A
中科院分区：
文献类型：
--
作者：
Compston, JE;McConachie, C;Jaffa, A
骨质疏松症是神经性厌食症的严重并发症，在受影响的青少年中可能导致骨量的永久性不足。这种骨疾病的病理生理学尚未明确定义。在这项前瞻性研究的26名年轻女性神经性厌食症，年龄13-20岁（平均16.5），我们测量了骨密度，全身成分和生化指标的骨转换超过1年的变化。在此期间，平均体重增加10 kg，身高显著增加，体重指数基线值和最终值分别为14.2 +/- 1.7和17.6 +/- 2.3 kg/m2（P < 0.001）。然而，在研究期间，脊柱或股骨近端的骨矿物质密度没有显著变化; 3个月和12个月时全身骨矿物质含量显著高于基线（P=0.001和P < 0.0001），但3个月时全身骨矿物质密度显著低于基线（P=0.003）。血清骨钙素和骨特异性碱性磷酸酶值显著增加，并在所有时间点均高于基线，而尿NTX/肌酐排泄在研究的前6个月显示无显著增加，但在12个月时，平均值显著低于基线。平均血清25-羟维生素D水平在6个月时显示显著降低（P < 0.05），但此后恢复至基线水平。与基线相比，所有时间点的血清甲状旁腺激素水平均显著升高，这些均在正常范围内。这些结果表明，虽然体重增加在年轻的骨质疏松症是与线性增长，骨矿物质密度并没有增加。这一缺陷是否可以在随后得到纠正，需要更长期的前瞻性研究。
Osteoporosis is a serious complication of anorexia nervosa and in affected adolescents may result in a permanent deficit in bone mass. The pathophysiology of this bone disease has not been clearly defined. In this prospective study of 26 young women with anorexia nervosa aged 13-20 years (mean 16.5) we have measured changes in bone mineral density, total body composition and biochemical indices of bone turnover over 1 year. Over this period there was a mean weight gain of 10 kg and significant height gain with baseline and final values for body mass index of 14.2 +/- 1.7 and 17.6 +/- 2.3 kg/m(2) (P < 0.001). However, no significant changes were seen in bone mineral density in the spine or proximal femur during the study; total body bone mineral content was significantly higher than baseline at 3 months and 12 months (P=0.001 and P < 0.0001), but total body bone mineral density at 3 months was significantly lower than baseline (P=0.003). Serum osteocalcin and bone-specific alkaline phosphatase values increased significantly and remained higher than baseline at all time points whereas urinary NTX/creatinine excretion showed a non-significant increase over the first 6 months of the study, but at 12 months, the mean value was significantly lower than baseline. Mean serum 25-hydroxyvitamin D levels showed a significant decrease at 6 months (P < 0.05), but returned towards baseline thereafter. There was a significant increase in serum parathyroid hormone levels at all time points compared to baseline, these occurring within the normal range. These results indicate that although weight gain in young anorexics is associated with linear growth, bone mineral density does not increase. Whether this deficit can be corrected subsequently requires longer-term prospective studies.