Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Curr Opin Endocrinol Diabetes Obes. 2011 Dec;18(6):376-82. doi: 10.1097/MED.0b013e32834b4bdc.
Anorexia nervosa is associated with low bone mineral density (BMD), concerning for an increased risk of fractures, and decreased bone accrual in adolescents, concerning for suboptimal peak bone mass. This review discusses causes of impaired bone health in anorexia nervosa and potential therapeutic strategies.
Low BMD in anorexia nervosa is consequent to decreased lean mass, hypogonadism, low insulin-like growth factor-1 (IGF-1), relative hypercortisolemia and alterations in hormones impacted by energy availability. Weight gain causes some improvement in bone accrual, but not to the extent observed in controls, and vitamin D supplementation does not increase BMD. Oral estrogen is not effective in increasing BMD, likely from IGF-1 suppressive effects. In contrast, transdermal estrogen replacement is effective in increasing bone accrual in adolescents with anorexia nervosa, although not to the extent seen in controls. Recombinant human IGF-1 increases bone formation in adolescents, and with oral estrogen increases BMD in adults with anorexia nervosa. Bisphosphonates increase BMD in adults, but not in adolescents, and should be used cautiously given their long half-life.
Further investigation is necessary to explore therapies for low BMD in anorexia nervosa. Weight gain is to be encouraged. Transdermal estrogen in adolescents, and bisphosphonates in adults, have a potential therapeutic role.
神经性厌食症与骨密度降低（BMD）有关，这会增加骨折风险，而青少年时期的骨量积累减少则会导致峰值骨量不足。本篇综述讨论了神经性厌食症中骨健康受损的原因和潜在的治疗策略。
神经性厌食症中的低 BMD 是由于瘦体重减少、性腺功能减退、胰岛素样生长因子-1（IGF-1）水平降低、相对皮质醇过多以及能量供应影响的激素改变所致。体重增加会使骨量积累有所改善，但改善程度不及对照组，且维生素 D 补充并不能增加 BMD。口服雌激素不能有效增加 BMD，可能是因为其具有抑制 IGF-1 的作用。相比之下，在青少年神经性厌食症患者中，经皮雌激素替代治疗能有效增加骨量积累，尽管其效果不及对照组。重组人生长激素 IGF-1 可增加青少年的骨形成，而与口服雌激素联合使用可增加成年神经性厌食症患者的 BMD。双膦酸盐可增加成年人的 BMD，但不能增加青少年的 BMD，且鉴于其半衰期较长，应谨慎使用。
需要进一步研究来探索神经性厌食症低 BMD 的治疗方法。应鼓励增加体重。经皮雌激素对青少年，双膦酸盐对成年患者有潜在的治疗作用。
