Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, BUL 457, 55 Fruit Street, Boston, MA 02114, USA.
Nat Rev Endocrinol. 2012 Jan 24;8(7):395-404. doi: 10.1038/nrendo.2011.238.
Gonadal steroids, including androgens and oestrogens, play a critical part in bone metabolism, and conditions associated with a deficiency of gonadal steroids can reduce BMD in adults and impair bone accrual in adolescents. In addition, other associated hormone alterations, for example, insulin-like growth factor 1 deficiency or high cortisol levels, can further exacerbate the effect of hypogonadism on bone metabolism, as can factors such as calcium and vitamin D deficiency, low body weight and exercise status. This Review discusses the effects of different hypogonadal states on bone metabolism in female adolescents and young adults, with particular emphasis on conditions associated with low energy availability, such as anorexia nervosa and athletic amenorrhoea, in which many factors other than hypogonadism affect bone. In contrast to most hypogonadal conditions, in which replacement of gonadal steroids is sufficient to normalize bone accrual rates and BMD, gonadal steroid replacement may not be sufficient to normalize bone metabolism in these states of energy deficit.
性腺类固醇，包括雄激素和雌激素，在骨骼代谢中起着关键作用，与性腺类固醇缺乏相关的病症会降低成年人的骨密度，并损害青少年的骨量积累。此外，其他相关的激素变化，例如胰岛素样生长因子 1 缺乏或皮质醇水平升高，会进一步加剧性腺功能减退对骨骼代谢的影响，而钙和维生素 D 缺乏、低体重和运动状况等因素也会产生影响。本综述讨论了不同的性腺功能减退状态对女性青少年和年轻成年人骨骼代谢的影响，特别强调了与低能量供应相关的病症，如神经性厌食症和运动性闭经，在这些病症中，除了性腺功能减退之外，还有许多其他因素会影响骨骼。与大多数性腺功能减退的情况不同，在这些情况下，性腺类固醇的替代足以使骨积累率和骨密度正常化，而在这些能量不足的状态下，性腺类固醇的替代可能不足以使骨骼代谢正常化。
