Schneider Marcie, Fisher Martin, Weinerman Stuart, Lesser Martin
Division of Adolescent Medicine, Department of Pediatrics, North Shore University Hospital, New York University School of Medicine, Manhasset, New York, USA.
Int J Adolesc Med Health. 2002 Oct-Dec;14(4):297-306. doi: 10.1515/ijamh.2002.14.4.297.
The objectives were to delineate those factors which correlate with low bone density in patients with anorexia nervosa and in turn to predict those at greatest risk for osteopenia.
Bone density was evaluated by dual energy x-ray absorptiometry in 28 postmenarchal females with anorexia nervosa who had never received hormonal therapy. Bone density results were correlated with specific historical and physical factors utilizing descriptive statistics, scatter plots, and the Spearman correlation coefficient.
Mean age was 18.6 years, mean age at menarche was 12.9 yrs, mean length of illness was 19.8 months and mean duration of amenorrhea was 13.4 months. Mean % ideal body weight was 84% at the time of bone density, 75% at minimum weight and 100% at maximum weight. Mean lumbar spine bone density was -1.69 standard deviations from the norm; mean lateral spine bone density was -1.45 standard deviations from the norm; mean femoral neck of the hip bone density was -1.18 standard deviations from the norm. There was a strong negative correlation between duration of amenorrhea and bone density at the lumbar spine (r = -0.50, p < .01) and a mild correlation at the lateral spine (r = -0.49, p < 0.05) and femoral neck (r = -0.41, p < 0.05). There was also a strong negative correlation between length of illness and bone density at the lumbar spine (r = -0.53, p < 0.01) and lateral spine (r = -0.77, p < 0.0001), and a mild correlation with the femoral neck (r = -0.48, p < 0.05). Scatter plots of lumbar bone density versus duration of amenorrhea, and versus length of illness clearly showed not only that longer duration of amenorrhea and longer length illness correlated to bone loss, but also strikingly that within a short time of being ill and amenorrheic, significant bone loss was seen. Age, and age at menarche correlated mildly with osteopenia at the lateral spine; age correlated mildly with osteopenia at the femoral neck as well. There was a trend for minimum BMI to correlate with osteopenia at the lateral spine. There were no correlations of bone density with % IBW at bone density, minimum % IBW, maximum % IBW, change in % IBW, BMI at the time of the bone density, maximum BMI or change in BMI.
Low bone density, especially in the lumbar spine, correlated with both a longer duration of amenorrhea and longer length of illness, but not with other factors, in our patients with anorexia nervosa. As many of these patients, even those with a short duration of illness and amenorrhea, were osteopenic, it is advisable to continue to perform bone density studies in all patients with anorexia nervosa, on both a clinical and research basis.
目的是确定与神经性厌食症患者低骨密度相关的因素，进而预测骨质减少风险最高的患者。
对28名初潮后从未接受过激素治疗的神经性厌食症女性进行双能X线吸收法骨密度评估。利用描述性统计、散点图和Spearman相关系数，将骨密度结果与特定的病史和体格检查因素进行关联分析。
平均年龄为18.6岁，平均初潮年龄为12.9岁，平均病程为19.8个月，平均闭经时间为13.4个月。骨密度检测时平均理想体重百分比为84%，最低体重时为75%，最高体重时为100%。腰椎平均骨密度低于正常标准1.69个标准差；脊柱侧位平均骨密度低于正常标准1.45个标准差；髋部股骨颈平均骨密度低于正常标准1.18个标准差。闭经时间与腰椎骨密度呈强负相关（r = -0.50，p < 0.01），与脊柱侧位呈轻度相关（r = -0.49，p < 0.05），与股骨颈呈轻度相关（r = -0.41，p < 0.05）。病程与腰椎骨密度呈强负相关（r = -0.53，p < 0.01），与脊柱侧位呈强负相关（r = -0.77，p < 0.0001），与股骨颈呈轻度相关（r = -0.48，p < 0.05）。腰椎骨密度与闭经时间和病程的散点图清楚地显示，不仅闭经时间越长和病程越长与骨质流失相关，而且在患病和闭经短时间内就出现了明显的骨质流失。年龄和初潮年龄与脊柱侧位骨质减少呈轻度相关；年龄与股骨颈骨质减少也呈轻度相关。最低体重指数与脊柱侧位骨质减少有相关趋势。骨密度与骨密度检测时的理想体重百分比、最低理想体重百分比、最高理想体重百分比、理想体重百分比变化、骨密度检测时的体重指数、最高体重指数或体重指数变化均无相关性。
在我们的神经性厌食症患者中，低骨密度，尤其是腰椎骨密度，与闭经时间延长和病程延长相关，与其他因素无关。由于许多这类患者，即使是病程和闭经时间短的患者也存在骨质减少，因此建议在临床和研究基础上，对所有神经性厌食症患者继续进行骨密度研究。
