Biomechanical Stimulation & Skeletal Health in Adolescents with Anorexia Nervosa

描述（由申请方提供）：神经性厌食症是一种慢性疾病，可导致显著的发病率和死亡率，包括青春期骨量增加受损。有效的预防和治疗策略仍不清楚。这项研究的重点是一种新型的非药物干预对骨标志物的短期和长期影响，以及预防AN青少年骨密度和强度的有害变化。候选人的长期职业目标是找到一种安全有效的干预措施，以防止这种慢性疾病对未来骨骼健康的长期负面影响。与这一目标相结合的是希望增加对预防高危儿童和青少年患者骨丢失策略的理解，并阐明导致这些人群骨骼缺陷的途径。拟议的职业发展计划包括在对候选人发展为独立研究者至关重要的4个领域的额外培训和指导：（1）骨生理学和生物力学;（2）流行病学和分析这些纵向数据所需的统计方法的高级培训;（3）使用新技术评估骨骼健康;以及（4）进一步发展领导和指导技能。研究计划包括3个目的：（1）确定低强度机械刺激（LMMS）对因AN住院的青少年骨转换的短期影响;（2）确定LMMS对患有a的非卧床青少年骨几何形状和骨强度的长期影响;（3）观察LMMS对非卧床青少年AN患者骨重建生化指标的长期影响。拟议的职业发展计划将提供必要的培训和数据，以支持R 01申请在奖励期的最后几年。这些研究的结果将具有广泛的临床意义，因为循证治疗方案可能源于这些数据，从而改善患有这种常见慢性疾病的青少年和年轻女性的护理。考虑到目前老年人骨质疏松症流行所带来的医疗负担，制定有效措施预防儿童和青少年时期的骨质流失至关重要。

DESCRIPTION (provided by applicant): Anorexia nervosa is a chronic illness resulting in significant morbidity and mortality, including the compromised accrual of bone mass during adolescence. Effective prevention and treatment strategies remain unclear. The proposed study focuses on the short-term and long term effects of a novel, nonpharmacologic intervention on bone markers, and the prevention of deleterious changes in bone density and strength in adolescents with AN. The Candidate's long-range career goal is to find a safe, efficacious intervention to prevent the longterm negative effects of this chronic illness on future bone health. Coupled with this goal is a desire to increase understanding of the strategies to prevent bone loss in at-risk pediatric and adolescent patients, and to elucidate the pathways that lead to skeletal deficits in these populations. The proposed career development plan includes additional training and mentorship in 4 areas critical to the Candidate's development as an independent investigator: (1) bone physiology and biomechanics; (2) advanced training in epidemiology and the statistical methods needed to analyze these longitudinal data; (3) use of novel techniques for assessment of skeletal health; and (4) further development of leadership and mentoring skills. The research plan includes 3 aims: (1) To determine the short-term effects of low magnitude mechanical stimulation (LMMS) on bone turnover in adolescents who are hospitalized for AN; (2) To determine the longterm effects of LMMS on bone geometry and bone strength in ambulatory adolescents with a ; and (3) To determine the longterm effects of LMMS on biochemical indices of bone remodeling in ambulatory adolescents with AN. The proposed career development plan will provide the training and data necessary to support an R01 application during the later years of the award period. The results of these studies will have broad-reaching clinical importance, as evidence-based treatment protocols will likely stem from these data that result in improved care achieved for adolescents and young women with this common chronic disease. Given the health care burden associated with the current epidemic of osteoporosis in the elderly, establishing effective measures to prevent bone loss during childhood and adolescence is paramount.