Centre for Eating Disorders, Odense University Hospital, Odense, Denmark.
Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark.
Int J Eat Disord. 2020 Apr;53(4):595-605. doi: 10.1002/eat.23245. Epub 2020 Feb 12.
Eating disorders (EDs) are associated with decreased bone mineral density (BMD) and increased fracture risk. The association between BMD and fracture risk in EDs is not well elucidated. We aimed to assess BMD in an ED cohort of patients with active disease and patients in remission, and to assess the predictive value of BMD on incidence of fractures.
We included 344 female patients (median age 19, IQR 16; 24) referred to ED treatment. Later, patients were invited to follow-up including assessment of remission status and a dual-energy x-ray absorptiometry (DXA)-scan. Information on fractures was obtained through the Danish National Registry of Patients.
Patients with current anorexia nervosa (AN) had significantly lower BMD compared to controls at lumbar spine (16% lower, p < .0001), femoral neck (18% lower, p < .0001), and total hip (23% lower, p < .0001). Recovered AN patients had higher BMD compared to those with current disease (p < .0001 for all measures), but lower BMD compared to controls at lumbar spine (p < .01) and hip (p < .001). BMD did not differ between BN patients and controls. In patients with active eating disorders not otherwise specified, BMD was lower only at the total hip (p < .005). We found no association between BMD and fracture risk.
We confirm that AN is associated with low BMD, whereas BN is not. Remission is associated with higher BMD compared to patients with active AN, but a deficit remains. We found no significant association between BMD and fracture risk, challenging the benefit of the widespread use of DXA scans in young women with ED.
The study is registered in ClinicalTrials.gov, number NCT00267228.
饮食失调（EDs）与骨密度（BMD）降低和骨折风险增加有关。ED 患者的 BMD 与骨折风险之间的关系尚未得到充分阐明。我们旨在评估患有活动期疾病和缓解期患者的 ED 患者队列中的 BMD，并评估 BMD 对骨折发生率的预测价值。
我们纳入了 344 名女性患者（中位数年龄 19 岁，IQR 16；24 岁），他们被转介接受 ED 治疗。之后，患者被邀请进行随访，包括评估缓解状态和双能 X 射线吸收法（DXA）扫描。骨折信息通过丹麦国家患者登记处获得。
目前患有神经性厌食症（AN）的患者与对照组相比，腰椎（低 16%，p<0.0001）、股骨颈（低 18%，p<0.0001）和全髋（低 23%，p<0.0001）的 BMD 显著降低。恢复的 AN 患者与目前患有疾病的患者相比，BMD 更高（所有指标均 p<0.0001），但与对照组相比，腰椎（p<0.01）和髋部（p<0.001）的 BMD 更低。BN 患者与对照组的 BMD 无差异。在患有其他特定饮食障碍的活动期患者中，仅全髋的 BMD 较低（p<0.005）。我们未发现 BMD 与骨折风险之间存在关联。
我们证实 AN 与低 BMD 相关，而 BN 则不然。与患有活动期 AN 的患者相比，缓解期患者的 BMD 较高，但仍存在不足。我们未发现 BMD 与骨折风险之间存在显著关联，这对广泛使用 DXA 扫描来评估患有 ED 的年轻女性的骨折风险提出了挑战。
该研究在 ClinicalTrials.gov 注册，编号为 NCT00267228。
