Fazeli Pouneh K, Faje Alexander T, Cross Ela J, Lee Hang, Rosen Clifford J, Bouxsein Mary L, Klibanski Anne
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Bone. 2015 Aug;77:6-11. doi: 10.1016/j.bone.2015.04.001. Epub 2015 Apr 11.
Anorexia nervosa (AN) is a psychiatric disorder characterized by self-induced starvation and low body weight. Women with AN have impaired bone formation, low bone mass and an increased risk of fracture. FGF-21 is a hormone secreted by the liver in starvation and FGF-21 transgenic mice have significant bone loss due to an uncoupling of bone resorption and bone formation. We hypothesized that FGF-21 may contribute to the low bone mass state of AN.
We studied 46 women: 20 with AN (median age [interquartile range]: 27.5 [25, 30.75] years) and 26 normal-weight controls (NWC) of similar age (25 [24, 28.5] years). We investigated associations between serum FGF-21 and 1) aBMD measured by dual energy X-ray absorptiometry, 2) parameters of bone microarchitecture in the distal radius and tibia measured by high-resolution peripheral quantitative CT and 3) bone strength, estimated by microfinite element analysis.
FGF-21 levels were similar in AN and NWC (AN: 33.1 [18.1, 117.0] pg/ml vs. NWC: 57.4 [23.8, 107.1] pg/ml; p = 0.54). There was a significant inverse association between log FGF-21 and trabecular number in the radius in both AN (R = -0.57, p < 0.01) and NWC (R=-0.53, p < 0.01) and a significant positive association between log FGF-21 and trabecular separation in the radius in AN (R = 0.50, p < 0.03) and NWC (R = 0.52, p < 0.01). Estimates of radial bone strength were inversely associated with log FGF-21 in AN (R = -0.50, p < 0.03 for both stiffness and failure load). There were no associations between FGF-21 and aBMD, cortical parameters or tibial parameters in the AN or NWC groups.
FGF-21 may be an important determinant of trabecular skeletal homeostasis in AN.
神经性厌食症（AN）是一种以自我诱导饥饿和低体重为特征的精神疾病。患有AN的女性骨形成受损、骨量低且骨折风险增加。成纤维细胞生长因子21（FGF - 21）是肝脏在饥饿状态下分泌的一种激素，FGF - 21转基因小鼠因骨吸收与骨形成解偶联而出现显著的骨质流失。我们推测FGF - 21可能与AN患者的低骨量状态有关。
我们研究了46名女性：20名患有AN（中位年龄[四分位间距]：27.5[25，30.75]岁）和26名年龄相仿的正常体重对照者（NWC，25[24，28.5]岁）。我们调查了血清FGF - 21与以下各项之间的关联：1）通过双能X线吸收法测量的骨密度（aBMD）；2）通过高分辨率外周定量CT测量的桡骨远端和胫骨的骨微结构参数；3）通过微有限元分析估算的骨强度。
AN组和NWC组的FGF - 21水平相似（AN组：33.1[18.1，117.0]pg/ml，NWC组：57.4[23.8，107.1]pg/ml；p = 0.54）。在AN组（R = -0.57，p < 0.01）和NWC组（R = -0.53，p < 0.01）中，logFGF - 21与桡骨小梁数量均呈显著负相关；在AN组（R = 0.50，p < 0.03）和NWC组（R = 0.52，p < 0.01）中，logFGF - 21与桡骨小梁间距均呈显著正相关。在AN组中，桡骨骨强度估计值与logFGF - 21呈负相关（刚度和破坏载荷的R均为 -0.50，p < 0.03）。在AN组或NWC组中，FGF - 21与aBMD、皮质参数或胫骨参数之间均无关联。
FGF - 21可能是AN患者小梁骨稳态的一个重要决定因素。
