Legroux-Gerot Isabelle, Vignau Jean, Collier Francis, Cortet Bernard
Department of Rheumatology, CHRU Lille, Hôpital Roger Salengro, 59037, Lille cédex, France.
Calcif Tissue Int. 2008 Nov;83(5):315-23. doi: 10.1007/s00223-008-9173-y. Epub 2008 Oct 4.
The purpose of this longitudinal study was to evaluate factors affecting changes in bone mineral density (BMD) in patients with anorexia nervosa (AN) and osteoporosis and, more particularly, to assess the benefits of hormone replacement therapy (HRT) on BMD in these patients. Our study involved 45 AN patients, 12 of whom had been treated by HRT for 2 years following a diagnosis of osteoporosis by densitometry (WHO criteria). Patients' mean age was 25.3 +/- 6.7 years. Mean duration of illness was 5.7 +/- 5.3 years. Serum calcium and phosphate were measured at baseline, as were bone remodeling markers. Osteodensitometry by dual-energy X-ray absorptiometry was performed at inclusion and after 2 years. After 2 years, no significant differences were observed between spine, femoral neck, and total hip BMDs either in the HRT group (P = 0.3, P = 0.59, P = 0.58) or in the nontreatment group (P = 0.17, P = 0.68, P = 0.98). Moreover, there were no significant differences between the two groups when changes in spine, femoral neck, and total hip BMDs at 2 years were compared (P = 0.72, P = 0.95, P = 0.58). In both groups, change in weight at 1 year correlated with change in spine BMD at 2 years (r = 0.35, P = 0.04) and change in total-hip BMD at 2 years (r = 0.35, P = 0.04) but not with change in femoral neck BMD at 2 years. Patients with a body mass index (BMI) > or = 17 kg/m(2) at 2 years showed a significant increase in total-hip BMD when compared with patients with a BMI < 17 kg/m(2) (+4.4% +/- 6.7 vs. -0.5% +/- 6.01, P = 0.03). No significant differences were observed for spine and femoral neck BMD. In patients who had recovered their menstrual cycle, significant increases were observed in spine BMD (+4% +/- 6.3 vs. -1.9% +/- 5.6, P = 0.008), femoral neck BMD (+3% +/- 6.2 vs. -2.4% +/- 8, P = 0.05), and total-hip BMD (+3% +/- 7.1 vs. -3.7% +/- 10, P = 0.04). Prevention of bone loss at 2 years in AN patients treated by HRT was not confirmed in this study. We did confirm that increase in weight at 1 year was the most predictive factor for the improvement of spine and hip BMD at 2 years.
这项纵向研究的目的是评估影响神经性厌食症（AN）合并骨质疏松症患者骨矿物质密度（BMD）变化的因素，更具体地说，是评估激素替代疗法（HRT）对这些患者BMD的益处。我们的研究纳入了45例AN患者，其中12例在通过骨密度测定法（WHO标准）诊断为骨质疏松症后接受了2年的HRT治疗。患者的平均年龄为25.3±6.7岁。平均病程为5.7±5.3年。在基线时测量血清钙和磷酸盐以及骨重塑标志物。在纳入研究时和2年后通过双能X线吸收法进行骨密度测定。2年后，HRT组的脊柱、股骨颈和全髋部BMD均无显著差异（P = 0.3，P = 0.59，P = 0.58），未治疗组也无显著差异（P = 0.17，P = 0.68，P = 0.98）。此外，比较两组2年时脊柱、股骨颈和全髋部BMD的变化时，也没有显著差异（P = 0.72，P = 0.95，P = 0.58）。在两组中，1年时体重的变化与2年时脊柱BMD的变化相关（r = 0.35，P = 0.04）以及与2年时全髋部BMD的变化相关（r = 0.35，P = 0.04），但与2年时股骨颈BMD的变化无关。2年时体重指数（BMI）≥17 kg/m²的患者与BMI＜17 kg/m²的患者相比，全髋部BMD显著增加（+4.4%±6.7 vs. -0.5%±6.01，P = 0.03）。脊柱和股骨颈BMD无显著差异。月经周期恢复的患者，脊柱BMD显著增加（+4%±6.3 vs. -1.9%±5.6，P = 0.008），股骨颈BMD增加（+3%±6.2 vs. -2.4%±8，P = 0.05），全髋部BMD增加（+3%±7.1 vs. -3.7%±10，P = 0.04）。本研究未证实HRT治疗的AN患者在2年时预防骨质流失的作用。我们确实证实1年时体重增加是2年时脊柱和髋部BMD改善的最具预测性的因素。
