Sum Melissa, Mayer Laurel, Warren Michelle P
Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 16-128, New York, NY 10032, USA.
J Osteoporos. 2011;2011:720328. doi: 10.4061/2011/720328. Epub 2011 Aug 23.
Osteopenia and osteoporosis are major complications of anorexia nervosa (AN). Since bone is a tissue requiring large amounts of energy, we examined the disproportionate increase in resting energy expenditure (REE) that occurs with refeeding of AN patients to determine if it was related to bone accretion. Thirty-seven AN patients aged 23.4 ± 4.8 years underwent a behavioral weight-gain protocol lasting a median of 66 days; 27 remained amenorrheic, and 10 regained menses. Sixteen controls aged 25.1 ± 4.7 years were age- and % IBW matched with patients. REE was measured using a respiratory chamber-indirect calorimeter. Significant correlations were found between REE and changes in spine (r = 0.48, P < 0.02) and leg (r = 0.43, P < 0.05) BMDs in AN patients. Further subgroup analysis of the amenorrheics revealed significant correlation between REE and change in spine BMD (r = 0.59, P < 0.02) and higher IGF-1 after weight gain compared to controls. Amenorrheics also had lower BMDs. These findings were absent in the regained menses group. The increase in REE seen in women with AN during nutritional rehabilitation may be related to active bone formation, which is not as prominent when menses have returned.
骨质减少和骨质疏松是神经性厌食症（AN）的主要并发症。由于骨骼是一种需要大量能量的组织，我们研究了AN患者重新进食时静息能量消耗（REE）不成比例的增加，以确定其是否与骨量增加有关。37名年龄在23.4±4.8岁的AN患者接受了为期66天的行为性体重增加方案；27人仍闭经，10人恢复月经。16名年龄在25.1±4.7岁的对照者在年龄和%IBW方面与患者匹配。使用呼吸室间接热量计测量REE。在AN患者中，发现REE与脊柱（r = 0.48，P < 0.02）和腿部（r = 0.43，P < 0.05）骨密度变化之间存在显著相关性。对闭经者的进一步亚组分析显示，REE与脊柱骨密度变化之间存在显著相关性（r = 0.59，P < 0.02），与对照组相比，体重增加后IGF-1更高。闭经者的骨密度也较低。在恢复月经的组中没有这些发现。在营养康复期间，AN女性中观察到的REE增加可能与活跃的骨形成有关，当月经恢复时，这种情况就不那么明显了。
