Zipfel S, Seibel M J, Löwe B, Beumont P J, Kasperk C, Herzog W
Department of General Internal and Psychosomatic Medicine, University of Heidelberg, 69115 Heidelberg, Germany.
J Clin Endocrinol Metab. 2001 Nov;86(11):5227-33. doi: 10.1210/jcem.86.11.8050.
This study prospectively investigated the course of bone mineral density (BMD) in patients with anorexia nervosa (AN) and bulimia nervosa (BN) over a 3.6-yr follow-up period. From an initial sample of 47 female patients with an eating disorder (T1), 38 (n = 24 AN; n = 14 BN) were reassessed at follow-up (T2) (participation rate, 80.1%). For nonrecovered AN patients at T2, prevalence rates of osteopenia (-1.0 SD > or = T-score > -2.5 SD) and osteoporosis (T-score < or = -2.5 SD) at the lumbar spine were 54.2 and 20.8%, respectively. Due to an annual loss of lumbar spine BMD (-3.7 +/- 4.9%) in the chronic AN patients and a slight but insignificant annual increase (0.7 +/- 1.7%) for those who recovered, the difference in BMD between both outcome groups was more pronounced at follow-up (0.93 +/- 0.13 vs. 1.14 +/- 0.13 g/cm2; P < 0.01). Nonrecovered AN patients with binge eating/purging type showed a significantly reduced BMD compared with patients with the restricting type (0.87 +/- 0.13 vs. 1.02 +/- 0.08 g/cm2; P = 0.02). Both at baseline and follow-up, AN patients had increased rates of bone resorption, as measured by urinary desoxypyridinoline, compared with a control group (n = 42) (11.4 +/- 4.4 vs. 10.4 +/- 7.8, P < 0.001, vs. 5.6 +/- 2.4 and 10.4 +/- 7.8 nM/mM creatinine, P < 0.05, respectively). The subtype of AN and body mass index were best predictors for BMD at the lumbar spine at follow-up (R2 = 0.576). With one exception, all bulimic patients had BMD and markers of bone turnover within the normal range. These results suggest that patients with chronic AN, particularly of the binge eating/purging type, are at high risk for osteoporosis and may need additional therapy to prevent bone loss.
本研究前瞻性地调查了神经性厌食症（AN）和神经性贪食症（BN）患者在3.6年随访期内的骨矿物质密度（BMD）变化过程。从47名患有饮食失调的女性患者初始样本（T1）中，38名（n = 24名AN；n = 14名BN）在随访时（T2）接受了重新评估（参与率为80.1%）。对于T2时未康复的AN患者，腰椎骨量减少（-1.0 SD≥T值＞-2.5 SD）和骨质疏松（T值≤-2.5 SD）的患病率分别为54.2%和20.8%。由于慢性AN患者腰椎BMD每年下降（-3.7±4.9%），而康复患者有轻微但不显著的每年增加（0.7±1.7%），两个结局组之间的BMD差异在随访时更为明显（0.93±0.13 vs. 1.14±0.13 g/cm2；P＜0.01）。与限制型患者相比，暴饮暴食/清除型未康复的AN患者BMD显著降低（0.87±0.13 vs. 1.02±0.08 g/cm2；P = 0.02）。在基线和随访时，与对照组（n = 42）相比，通过尿脱氧吡啶啉测量，AN患者的骨吸收速率均增加（分别为11.4±4.4 vs. 10.4±7.8，P＜0.001，以及5.6±2.4和10.4±7.8 nM/mM肌酐，P＜0.05）。AN的亚型和体重指数是随访时腰椎BMD的最佳预测指标（R2 = 0.576）。除一例例外，所有贪食症患者的BMD和骨转换标志物均在正常范围内。这些结果表明，慢性AN患者，尤其是暴饮暴食/清除型患者，骨质疏松风险高，可能需要额外治疗以预防骨质流失。
