Nagata Jason M, Golden Neville H, Leonard Mary B, Copelovitch Lawrence, Denburg Michelle R
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
J Bone Miner Res. 2017 May;32(5):1082-1089. doi: 10.1002/jbmr.3068. Epub 2017 Jan 19.
Though previous studies have demonstrated an increased fracture risk in females with anorexia nervosa (AN), fracture risk in males is not well characterized. The objective of this study was to examine sex differences in fracture risk and site-specific fracture incidence in AN. We performed a population-based retrospective cohort study using The Health Improvement Network (THIN; a large database of anonymized electronic medical records collected at primary care clinics throughout the United Kingdom). The median calendar year for the start of the observation period was 2004-2005. We identified 9239 females and 556 males <60 years of age with AN, and 97,889 randomly selected sex-, age-, and practice-matched participants without eating disorders (92,329 females and 5560 males). Multivariable Cox regression was used to estimate the hazard ratio (HR) for incident fracture. Median age at start of observation was 29.8 years in females and 30.2 years in males. The HR for fracture associated with AN differed by sex and age (interaction p = 0.002). Females with AN had an increased fracture risk at all ages (HR, 1.59; 95% confidence interval [CI], 1.45 to 1.75). AN was associated with a higher risk of fracture among males >40 years of age (HR, 2.54; 95% CI, 1.32 to 4.90; p = 0.005) but not among males ≤40 years. Females with AN had a higher risk of fracture at nearly all anatomic sites. The greatest excess fracture risk was noted at the hip/femur (HR, 5.59; 95% CI, 3.44 to 9.09) and pelvis (HR, 4.54; 95% CI, 2.42 to 8.50) in females and at the vertebrae (HR, 7.25; 95% CI, 1.21 to 43.45) for males with AN. AN was associated with higher incident fracture risk in females across all age groups and in males >40 years old. Sites of highest fracture risk include the hip/femur and pelvis in females and vertebrae in males with AN. © 2016 American Society for Bone and Mineral Research.
尽管先前的研究表明神经性厌食症（AN）女性的骨折风险增加，但男性的骨折风险特征尚不明确。本研究的目的是探讨AN患者骨折风险和特定部位骨折发生率的性别差异。我们使用健康改善网络（THIN；英国各地基层医疗诊所收集的匿名电子病历大型数据库）进行了一项基于人群的回顾性队列研究。观察期开始的中位日历年为2004 - 2005年。我们确定了9239名年龄小于60岁的AN女性和556名男性，以及97,889名随机选择的无饮食失调的性别、年龄和医疗机构匹配的参与者（92,329名女性和5560名男性）。采用多变量Cox回归估计骨折发生风险比（HR）。观察开始时女性的中位年龄为29.8岁，男性为30.2岁。与AN相关的骨折HR因性别和年龄而异（交互作用p = 0.002）。所有年龄段的AN女性骨折风险均增加（HR，1.59；95%置信区间[CI]，1.45至1.75）。AN与40岁以上男性骨折风险较高相关（HR，2.54；95% CI，1.32至4.90；p = 0.005），但与40岁及以下男性无关。AN女性几乎在所有解剖部位的骨折风险都较高。女性中髋部/股骨（HR，5.59；95% CI，3.44至9.09）和骨盆（HR，4.54；95% CI，2.42至8.50）的骨折风险增加最为明显，而AN男性中椎骨骨折风险增加最为明显（HR，7.25；95% CI，1.21至43.45）。AN与所有年龄组的女性以及40岁以上男性的骨折发生风险较高相关。骨折风险最高的部位在女性中为髋部/股骨和骨盆，在AN男性中为椎骨。© 2016美国骨与矿物质研究学会
