Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK.
Connect-Eating Disorders Service, Greater Glasgow & Clyde NHS, United Kingdom.
Bone. 2018 Nov;116:22-27. doi: 10.1016/j.bone.2018.03.022. Epub 2018 Mar 27.
Anorexia nervosa (AN) during childhood and adolescence has been reported to adversely affect bone health, but few studies have investigated longitudinal changes.
DXA-derived bone parameters and body composition were retrospectively assessed in 111 young girls with AN with a median age of 15.4 years (10.9, 19.8). In 68 (61%) vertebral fracture assessment (VFA) was performed and in 31 (28%), a follow-up DXA was performed. Correlations with growth, changes in body composition and effects of illness duration and menstruation were examined. Size adjusted DXA standard deviation scores were calculated for total body (TB) less head bone mineral content (TBLH-BMC) and lumbar spine bone mineral apparent density (LS-BMAD).
Mean (range) bone area (BA) for height centile was 27.1 (0-97), and mean lean mass for height centile was 28.8 (0-95) at baseline. Mean (range) LS BMAD was -1.0 (-2.6, 0.8) SDS at first and - 1.2 (-3.0, -0.2) at second DXA (p = 0.023). On follow up, lean mass for height increased from 27th centile (0, 75) to 40th centile (0, 70) (p = 0.006), and fat mass for height increased from 55 g/cm to 67 g/cm (11.3, 124.2) (p < 0.001). Duration of illness was the only negative predictor of LS BMAD (p < 0.0001). Change in height SDS was the only positive predictor of change in TBLH-BMC (r = 0.384, p = 0.037), and change in LS BMAD (r-0.934, p < 0.0001). Of 68 patients who had VFA, 4 (5.9%) had a mild vertebral fracture.
Bones are smaller and less dense in childhood/adolescent AN compared to healthy adolescents. Although there are significant gains in lean mass and fat mass, over time, BMAD SDS decreases slightly. Improvement in BMAD SDS is related to improvement in height SDS.
据报道，儿童和青少年时期的神经性厌食症会对骨骼健康产生不利影响，但很少有研究调查其纵向变化。
回顾性评估了 111 名年龄中位数为 15.4 岁（10.9 岁，19.8 岁）的患有神经性厌食症的年轻女孩的 DXA 衍生骨参数和身体成分。在 68 例（61%）中进行了椎体骨折评估，在 31 例（28%）中进行了随访 DXA。检查了与生长、身体成分变化以及疾病持续时间和月经的关系。计算了全身（TB）减去头部骨矿物质含量（TBLH-BMC）和腰椎骨矿物质表观密度（LS-BMAD）的大小调整 DXA 标准差评分。
基线时，身高百分位的平均（范围）骨面积（BA）为 27.1（0-97），身高百分位的平均瘦体重为 28.8（0-95）。第一次 DXA 的平均（范围）LS BMAD 为-1.0（-2.6，0.8）SDS，第二次 DXA 为-1.2（-3.0，-0.2）（p=0.023）。随访时，身高的瘦体重从第 27 百分位（0，75）增加到第 40 百分位（0，70）（p=0.006），身高的脂肪量从 55g/cm 增加到 67g/cm（11.3，124.2）（p<0.001）。疾病持续时间是 LS BMAD 的唯一负预测因子（p<0.0001）。身高 SDS 的变化是 TBLH-BMC 变化的唯一正预测因子（r=0.384，p=0.037），LS BMAD 变化的正预测因子（r=-0.934，p<0.0001）。在进行 VFA 的 68 例患者中，有 4 例（5.9%）发生轻度椎体骨折。
与健康青少年相比，儿童和青少年时期的神经性厌食症患者的骨骼更小、密度更低。尽管瘦体重和脂肪量有显著增加，但随着时间的推移，BMAD SDS 略有下降。BMAD SDS 的改善与身高 SDS 的改善有关。
