Gordon Catherine M, Nelson Lawrence M
Children's Hospital Bone Health Center and Department of Pediatrics, Harvard Medical School, Divisions of Adolescent/Young Adult Medicine and Endocrinology, Children's Hospital, Boston, Massachusetts 02115, USA.
Curr Opin Obstet Gynecol. 2003 Oct;15(5):377-84. doi: 10.1097/00001703-200310000-00005.
We present an update on amenorrhea in adolescent girls and young women. Amenorrhea may herald the onset of estrogen deficiency, which can adversely affect peak bone mass and ultimate risk of osteoporosis.
Adolescence is a critical period for bone accretion. Important modifiable factors that optimize bone accretion during this time are calcium intake, vitamin D, nutrition, and exercise. Another modifiable factor in the hands of the clinician is the prompt recognition and therapy of amenorrhea associated with estrogen deficient states, caused by conditions such as hyperprolactinemia and ovarian failure. An important recent observation is that adolescents with amenorrhea who diet, but who do not meet diagnostic criteria for anorexia nervosa, are nonetheless at significant risk for low bone density. Also, multiple factors contribute to the bone loss experienced by patients with anorexia nervosa, and the associated estrogen deficiency may not be the major contributor. Recent evidence also suggests that the contraceptive depot medroxyprogesterone acetate may contribute to impaired bone accretion. While estrogen/progestin replacement therapy has a clear role in the management of girls and young women with primary ovarian insufficiency, the exact role of this therapy in the amenorrhea associated with anorexia nervosa or exercise remains controversial.
Increasingly, osteoporosis prevention is recognized as an important role for health care providers of adolescent girls and young women. Viewed from this perspective, there is a need for more aggressive evaluation and management of amenorrhea, and research is needed to define sound and cost effective strategies.
我们提供关于青春期女孩和年轻女性闭经的最新情况。闭经可能预示着雌激素缺乏的开始，这会对峰值骨量和骨质疏松的最终风险产生不利影响。
青春期是骨量增加的关键时期。在此期间优化骨量增加的重要可改变因素包括钙摄入、维生素D、营养和运动。临床医生可控制的另一个可改变因素是及时识别和治疗由高催乳素血症和卵巢功能衰竭等疾病引起的与雌激素缺乏状态相关的闭经。最近一项重要观察结果是，闭经的青少年虽节食但不符合神经性厌食症诊断标准，然而仍有显著的低骨密度风险。此外，多种因素导致神经性厌食症患者的骨质流失，且相关的雌激素缺乏可能并非主要因素。最近的证据还表明，长效醋酸甲羟孕酮避孕针可能会导致骨量增加受损。虽然雌激素/孕激素替代疗法在原发性卵巢功能不全的女孩和年轻女性的管理中具有明确作用，但该疗法在与神经性厌食症或运动相关的闭经中的确切作用仍存在争议。
越来越多的人认识到预防骨质疏松是青春期女孩和年轻女性医疗保健提供者的一项重要职责。从这个角度来看，需要对闭经进行更积极的评估和管理，并且需要开展研究以确定合理且具有成本效益的策略。
