Escalante Boleas M, Franco Vicario R, Bustamante Murga V, Miguel de la Villa F
Servicio de Medicina Interna, Hospital de Basurto, Bilbao, Bizcaia.
An Med Interna. 2002 Mar;19(3):143-50.
Eating disorders (anorexia and bulimia nervosa) are present in 1-3% of young female women. A later beginning, prolonged amenorrhea and low body mass index are risk factors of osteopenia in bulimic patients. Bone demineralization in anorexia nervosa is due to a greater resorption than bone formation leading to osteopenia, secondary osteoporosis and increased risk of pathologic fractures. Pathophysiology of bone disease includes factors as long duration of amenorrhea, deficient absorption of calcium, extreme physical exercise, 1.25 vitamin D deficiency, low creatinine clearance, increased blood and urinary cortisol and high levels of GH. Proposed treatments are nutritional improvement and weight gain (the most important), calcium supplementation, moderate exercise, estrogens, antidepressive drugs, fluoride in selected cases, byphosphonates and recombinant human IGF-1. An adequate questionnaire is essential in women with slightly decreased weight and menstrual disorders.
饮食失调（神经性厌食症和神经性贪食症）在1% - 3%的年轻女性中存在。发病较晚、长期闭经和低体重指数是贪食症患者骨质减少的危险因素。神经性厌食症中的骨质脱矿是由于骨吸收大于骨形成，导致骨质减少、继发性骨质疏松以及病理性骨折风险增加。骨病的病理生理学包括闭经时间长、钙吸收不足、过度体育锻炼、1,25 - 维生素D缺乏、肌酐清除率低、血液和尿液皮质醇增加以及生长激素水平高等因素。建议的治疗方法包括营养改善和体重增加（最重要）、补充钙、适度运动、雌激素、抗抑郁药物、在特定情况下使用氟化物、双膦酸盐和重组人胰岛素样生长因子 - 1。对于体重略有下降和月经紊乱的女性，一份合适的问卷至关重要。
