Fractures in women with eating disorders-Incidence, predictive factors, and the impact of disease remission: Cohort study with background population controls
Fractures in women with eating disorders-Incidence, predictive factors, and the impact of disease remission: Cohort study with background population controls
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DOI：
10.1002/eat.23223
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发表时间：
2020-01-10
影响因子：
5.5
通讯作者：
Stoving, Rene K.
中科院分区：
文献类型：
--
作者：
Frolich, Jacob;Winkler, Laura A.;Stoving, Rene K.
目的与一般人群相比，饮食失调（ED）患者的营养不良和低体重与骨折风险增加相关。在一项队列研究中，我们的目的是确定骨折率与年龄和性别匹配的对照组（比例5：1）相比，评估疾病缓解对骨折风险的影响，并建立骨折的预测因素。值得注意的是，803例艾德患者在1994年和2004年之间提到专门的艾德治疗。2016年，骨折数据通过丹麦国家患者登记处获得。结果神经性厌食症（AN; IRR 2.2 [CI 99%：1.6-3.0]）骨折风险增加，但神经性贪食症（BN; IRR 1.3，ns）或其他特定的进食障碍（OSFED; IRR 1.8，ns）骨折风险不增加。AN组中椎骨骨折（IRR 3.8 [CI 99%：1.4-10.3]）、上臂骨折（IRR 3.0 [CI 99%：1.6-5.5]）和髋部骨折（IRR 6.6 [CI 99%：2.6-18.0]）的IRR增加。与活动性疾病相比，AN的疾病缓解与骨折风险降低相关，但与对照组相比，骨折风险较高（IRR 1.7 [CI 99%：1.1-2.7]）。在回归分析中，首次发病时的年龄、最低BMI和转诊治疗前的病程是骨折的独立预测因素。讨论我们证实AN患者骨折风险增加，疾病缓解期患者和活动期患者骨折风险存在显著差异。此外，我们发现，初次发病时的年龄和转诊治疗前的病程与骨折风险呈正相关，而最低BMI与骨折风险呈负相关。
Objective Malnutrition and low weight in eating disorders (EDs) are associated with increased fracture risk compared to the general population. In a cohort study, we aimed to determine fracture rates compared to age and gender matched controls (ratio 5:1), assess the impact of disease remission on fracture risk, and establish predictive factors for fractures. Method Of note, 803 ED patients referred to specialized ED treatment between 1994 and 2004 were included. In 2016, data on fractures were obtained through the Danish National Registry of Patients. Results Fracture risk was increased in anorexia nervosa (AN; IRR 2.2 [CI 99%: 1.6-3.0]) but not in bulimia nervosa (BN; IRR 1.3, ns) or other specified feeding or eating disorders (OSFED; IRR 1.8, ns). IRR in the AN group were increased for vertebral fractures (IRR 3.8 [CI 99%: 1.4-10.3]), upper arm (IRR 3.0 (CI 99% 1.6-5.5) and hip (IRR 6.6 [CI 99%: 2.6-18.0]). Disease remission in AN is associated to lower fracture risk compared to active disease, but higher fracture risk compared to controls (IRR 1.7 [CI 99%: 1.1-2.7]). In regression analysis, age at debut of disease, nadir BMI and duration of disease before referral to treatment, independently predicted fracture. Discussion We confirm increased fracture risk in AN, and show significant differences in fracture risk between patients in disease remission and patients with active disease. Furthermore, we show that age at debut of disease and duration of disease before referral to treatment is positively correlated to fracture risk, whereas nadir BMI is negatively correlated to fracture risk.