THE CLINICAL COURSE OF OSTEOPOROSIS IN ANOREXIA-NERVOSA - A LONGITUDINAL-STUDY OF CORTICAL BONE MASS
THE CLINICAL COURSE OF OSTEOPOROSIS IN ANOREXIA-NERVOSA - A LONGITUDINAL-STUDY OF CORTICAL BONE MASS
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DOI：
10.1001/jama.265.9.1133
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发表时间：
1991-03-06
影响因子：
120.7
通讯作者：
NUSSBAUM, SR
中科院分区：
文献类型：
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作者：
RIGOTTI, NA;NEER, RM;NUSSBAUM, SR
患有神经性厌食症的女性骨量减少，可能会发生骨折。 这种骨质疏松症的病理生理学及其自然史都是未知的。 为了研究骨质疏松症的临床过程，我们随访了27名神经性厌食症妇女，中位时间为25个月（范围，9至53个月）。 在研究开始时，通过桡骨干的单光子吸收测定法测量的皮质骨密度较低（平均值+/- SD，0.63 +/- 0.07 g/cm 2），与闭经持续时间呈负相关（r = -0.49）。 在随访期间，大多数患者体重增加（n = 19），服用钙补充剂（n = 16），定期锻炼（n = 22），但不到一半的患者达到理想体重的80%或以上（n = 11），恢复月经（n = 6）或接受雌激素（n = 4）。 随访期间，整个组的皮质骨密度稳定;平均年变化（+/-SD）为+0.005（+/- .015）g/cm 2（95%置信区间，-0.0009至+0.0109）。 在达到80%理想体重的妇女和那些没有达到理想体重的妇女之间，或者在恢复月经、服用雌激素或钙或剧烈运动的妇女之间，骨密度的平均变化没有显著差异。在随访期间，在3名女性中临床观察到4例骨折。非脊柱骨折的发生率为0.05/人/年（95%可信区间为0.02 ~ 0.13），超过了该年龄段的正常女性（相对危险度为7.1; 95%可信区间为2.3 ~ 18.5）。 我们的结论是，皮质骨密度的减少似乎不能迅速逆转神经性厌食症的恢复，厌食症的妇女可能有骨折的风险增加。
Women with anorexia nervosa have reduced bone mass and may develop fractures. Neither the pathophysiology of this osteoporosis nor its natural history is known. To study the clinical course of osteoporosis, we followed up 27 women with anorexia nervosa for a median of 25 months (range, 9 to 53 months). At study entry, cortical bone density, measured by single-photon absorptiometry of the radial shaft, was low (mean +/- SD, 0.63 +/- 0.07 g/cm2) and inversely related to the duration of amenorrhea (r = -0.49). During follow-up, most patients gained weight (n = 19), took calcium supplements (n = 16), and exercised regularly (n = 22), but fewer than half reached 80% or more of ideal body weight (n = 11), resumed menses (n = 6), or received estrogen (n = 4). Cortical bone density was stable during follow-up for the group as a whole; the mean annual change (+/-SD) was +0.005 (+/- .015) g/cm2 (95% confidence interval, -0.0009 to +0.0109). There was no significant difference in the mean change in bone density between women who attained 80% of ideal weight and those who did not or between groups who did or did not regain menses, take estrogen or calcium, or exercise vigorously. Four fractures were clinically observed in three women during follow-up. The rate of 0.05 nonspine fractures per person-year (95% confidence interval, 0.02 to 0.13) exceeds that of normal women in this age range (relative risk, 7.1; 95% confidence interval, 2.3 to 18.5). We conclude that reductions in cortical bone density appear not to be rapidly reversed recovery from anorexia nervosa and that anorectic women may have an increased risk of fracture.