Park Jong Seok, Lee Hong Seop, Won Sung Hun, Lee Dhong Won, Jung Ki Jin, Kim Chang Hyun, Kim Ja Hyung, Lee Won Seok, Ryu Aeli, Kim Woo Jong
Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan.
Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, 68, Hangeulbiseok-ro, Nowon-gu.
Medicine (Baltimore). 2019 Jul;98(29):e16499. doi: 10.1097/MD.0000000000016499.
Anorexia nervosa is a chronic psychiatric disease defined by severe weight loss, due to fear of obesity, and self-imposed semi-starvation. Of the many complications following anorexia nervosa, low bone mineral density (BMD) is a significant risk factor for fractures. Anorexia nervosa is associated with higher risk of incident fracture in females across all age groups, and in males >40 years old. Sites at highest risk of fracture include the hip/femur and pelvis in females, and vertebrae in males with anorexia nervosa.
A 29-year-old woman known to have suffered from anorexia nervosa 15 years ago visited the emergency department due to right hip pain after falling while getting out of a taxi. During the period of anorexia nervosa, she had a body mass index (BMI) of 14.06 kg/m (weight, 36 kg; height, 1.60 m) and suffered from amenorrhea. At the time of presentation, she had a BMI of 19.53 kg/m (weight, 50 kg; height, 1.60 m) and had regular menstrual periods, indicating clinical recovery from anorexia nervosa.
Plain radiography, computed tomography, and bone scintigraphy revealed AO 31-A2.2 type right hip proximal femur intertrochanteric fracture. The BMD showed a T score of -3.9 in the hip and -3.6 at the lumbar level, indicating severe osteoporosis.
Osteosynthesis was performed with proximal femoral nail antirotation (PFNA) and wiring.
There were no specific symptoms, such as trauma or infection, during postoperative rehabilitation and postoperative management, and she was discharged after 2 weeks. After 1 year of follow-up at our outpatient clinic, she had no complications.
Here, we describe an unusual case of unilateral femoral intertrochanteric fracture that occurred after clinical recovery from anorexia nervosa. This case indicated that the risk of fracture remains even after recovery of BMI. We propose that women who have clinically recovered from anorexia nervosa should be advised to undergo annual osteodensitometric analyses after consulting with specialists in other areas (psychiatry, endocrinology, eating disorders).
神经性厌食症是一种慢性精神疾病，其特征为因恐惧肥胖和自我施加的半饥饿状态导致严重体重减轻。在神经性厌食症引发的众多并发症中，低骨密度（BMD）是骨折的一个重要风险因素。神经性厌食症在所有年龄组的女性以及40岁以上的男性中，引发骨折的风险更高。神经性厌食症患者骨折风险最高的部位，女性为髋部/股骨和骨盆，男性为脊椎。
一名29岁女性，15年前曾患神经性厌食症，因下车时摔倒后出现右髋部疼痛而前往急诊科就诊。在神经性厌食症患病期间，她的体重指数（BMI）为14.06kg/m²（体重36kg，身高1.60m），且闭经。就诊时，她的BMI为19.53kg/m²（体重50kg，身高1.60m），月经周期正常，表明已从神经性厌食症临床康复。
X线平片、计算机断层扫描和骨闪烁显像显示为AO 31 - A2.2型右髋部股骨近端粗隆间骨折。骨密度显示髋部T值为 - 3.9，腰椎水平为 - 3.6，表明患有严重骨质疏松症。
采用股骨近端抗旋髓内钉（PFNA）和钢丝进行骨内固定术。
术后康复和术后管理期间未出现创伤或感染等特殊症状，2周后出院。在我院门诊随访1年后，她未出现并发症。
在此，我们描述了一例在从神经性厌食症临床康复后发生的单侧股骨粗隆间骨折的罕见病例。该病例表明，即使体重指数恢复正常，骨折风险依然存在。我们建议，从神经性厌食症临床康复的女性在咨询其他领域（精神病学、内分泌学、饮食失调）的专家后，应接受每年一次的骨密度分析。
