Dominguez Jennifer, Goodman Linnea, Sen Gupta Surupa, Mayer Laurel, Etu Sarah Fischer, Walsh B Timothy, Wang Jack, Pierson Richard, Warren Michelle P
Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
Am J Clin Nutr. 2007 Jul;86(1):92-9. doi: 10.1093/ajcn/86.1.92.
Recovery from osteoporosis in anorexia nervosa (AN) is uncertain.
The purpose of this study was to understand the changes in bone mineral density (BMD) in women with AN and the mechanisms of recovery from osteopenia.
We studied BMD and markers of bone formation and resorption, osteocalcin and N-telopeptide (NTX), in patients with AN (n=28) who were following a behavioral weight-gain protocol.
Anorexic patients experienced significant percentage increases in BMD (4.38 +/- 7.48% for spine; 3.77 +/- 8.8% for hip; P<0.05 for both) from admission until recovery of 90% ideal body weight, achieved over 2.2 mo. NTX concentrations were higher in patients with AN at admission than in healthy control subjects (n=11; 69.0 +/- 31.09 and 48.3 +/- 14.38 nmol/mmol creatinine, respectively; P<0.05) and in reference control subjects (n=30; 69.0 +/- 31.09 and 37.0+/-6.00 nmol/mmol creatinine, respectively; P<0.001). In weight-recovered subjects with AN, osteocalcin increased (from 8.0 +/- 3.05 to 11.2 +/- 6.54 ng/mL; P<0.05), whereas NTX remained elevated (from 69.0 +/- 31.09 to 66.7 +/- 45.5 nmol/mmol creatinine; NS). A decrease in NTX (from 70.7 +/- 40.84 to 45.9 +/- 22.72 nmol/mmol creatinine; NS) occurred only in the subgroup of subjects who regained menses with weight recovery.
Nutritional rehabilitation induces a powerful anabolic effect on bone. However, a fall of NTX and a shift from the dominant resorptive state, which we postulate involves full recovery, may involve a hormonal mechanism and require a return of menses. Nutritional rehabilitation appears to be critical to bone recovery and may explain the ineffectiveness of estrogen treatment alone on BMD in the cachectic state.
神经性厌食症（AN）患者骨质疏松的恢复情况尚不确定。
本研究旨在了解AN女性患者骨密度（BMD）的变化以及骨质减少恢复的机制。
我们对28例遵循行为性体重增加方案的AN患者的BMD以及骨形成和骨吸收标志物骨钙素和N-端肽（NTX）进行了研究。
厌食症患者从入院到恢复至理想体重的90%（在2.2个月内实现）期间，脊柱BMD显著增加（4.38±7.48%），髋部BMD显著增加（3.77±8.8%）（两者P<0.05）。入院时AN患者的NTX浓度高于健康对照者（n = 11；分别为69.0±31.09和48.3±14.38 nmol/mmol肌酐；P<0.05）以及参考对照者（n = 30；分别为69.0±31.09和37.0±6.00 nmol/mmol肌酐；P<0.001）。在体重恢复的AN患者中，骨钙素增加（从8.0±3.05 ng/mL增至11.2±6.54 ng/mL；P<0.05），而NTX仍保持升高（从69.0±31.09增至66.7±45.5 nmol/mmol肌酐；无统计学意义）。仅在体重恢复且月经恢复的亚组患者中，NTX有所下降（从70.7±40.84降至45.9±22.72 nmol/mmol肌酐；无统计学意义）。
营养康复对骨骼具有强大的合成代谢作用。然而，NTX的下降以及从主要的骨吸收状态转变（我们推测这涉及完全恢复）可能涉及一种激素机制，并且需要月经恢复。营养康复似乎对骨骼恢复至关重要，这可能解释了在恶病质状态下单独使用雌激素治疗对BMD无效的原因。
