Nicaise D, Beaumesnil M, Chaillou E, Wagner A-C, Avarello G, Audran M, Giniès J-L
Service de pédiatrie, centre Robert-Debré, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 09, France.
Arch Pediatr. 2012 Jan;19(1):17-21. doi: 10.1016/j.arcped.2011.10.022. Epub 2011 Dec 1.
Anorexia nervosa is responsible for abnormalities in bone mineralization, which are well known and described in adults, but less well documented in adolescents. The aim of this research was to evaluate the frequency and severity and to determine predictive factors for these abnormalities in a population of adolescents with diagnosed anorexia nervosa.
This retrospective study involved 39 female adolescents with anorexia nervosa having undergone dual energy X-ray absorptiometry prior to the age of 18 years. Clinical (age, Tanner puberty stages, weight, body mass index [BMI] at different times during the anorexia phase and amenorrhea features), radiological (bone mineral density [BMD] in Z-score units and in absolute values), and biological (calcemia and vitamin D) parameters were collected.
In total, 20 patients (51%) presented osteopenia (Z-score <-1 DS and >-2.5 DS) and 2 (5%) had osteoporosis (Z-score <-2.5 DS). Five (13%) exhibited a Z-score less than -2 DS. BMD expressed in Z-scores correlated with none of the parameters assessed. At univariate analysis, BMD in absolute values correlated with the age at disease onset, BMI, weight loss at the lowest weight achieved and BMI at the time of densitometry (P<0.01). At multivariate analyses, only the correlation with the age at disease onset persisted (P<0.05).
Bone loss in anorexia nervosa is a complication that may be present as early as adolescence. It must be systematically searched for in all adolescents with severe malnutrition because, even if BMD correlated with nutritional parameters, no clinical predictor for osteoporosis or osteopenia could be identified in this study.
神经性厌食症会导致骨矿化异常，这在成年人中已广为人知并有所描述，但在青少年中的记录较少。本研究的目的是评估这些异常的发生率和严重程度，并确定诊断为神经性厌食症的青少年人群中这些异常的预测因素。
这项回顾性研究纳入了39名18岁之前接受过双能X线吸收测定法检查的神经性厌食症女性青少年。收集了临床（年龄、坦纳青春期分期、体重、厌食症阶段不同时间的体重指数[BMI]和闭经特征）、放射学（以Z评分单位和绝对值表示的骨密度[BMD]）和生物学（血钙和维生素D）参数。
总共20名患者（51%）出现骨质减少（Z评分<-1标准差且>-2.5标准差），2名（5%）患有骨质疏松症（Z评分<-2.5标准差）。5名（13%）的Z评分小于-2标准差。以Z评分表示的BMD与所评估的任何参数均无相关性。在单因素分析中，绝对值表示的BMD与疾病发病年龄、BMI、达到最低体重时的体重减轻以及骨密度测定时的BMI相关（P<0.01）。在多因素分析中，仅与疾病发病年龄的相关性仍然存在（P<0.05）。
神经性厌食症导致的骨质流失是一种并发症，可能早在青春期就出现。在所有严重营养不良的青少年中都必须系统地进行检查，因为即使BMD与营养参数相关，但在本研究中未发现骨质疏松症或骨质减少的临床预测指标。
