ACUTE at Denver Health, Denver, Colorado, USA.
Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
Int J Eat Disord. 2021 May;54(5):903-907. doi: 10.1002/eat.23506. Epub 2021 Mar 29.
Low bone mineral density (BMD) in anorexia nervosa (AN) leads to increased risk of fractures. Debate exists whether to medicinally treat young patients with AN based on abnormal dual-energy x-ray absorptiometry (DXA) scores or to weight restore and reassess when older. Trabecular bone score (TBS), a technology measuring bone quality, is used in conjunction with DXA. This report explores the potential additional value of TBS, in adults with severe AN, to augment the DXA diagnostic information.
Seventy-one DXA scans were reanalyzed to obtain TBS results from patients (mean age: 36.3 years). Differences in laboratory, anthropometric values and concomitant DXA measurements in relation to TBS results are reported.
For the cohort, mean body mass index (BMI) was 13.6 kg/m (SD: 2.1). The vast majority of patients had normal TBS with a mean of 1.395 (SD: 0.08) but, most patients (69%) had abnormal average DXA BMD Z-scores of -2.2 (SD: 1.2). The patients who also demonstrated degraded bone quality on TBS had significantly lower percent ideal body weight and elevated alkaline phosphatase compared to patients with normal TBS (p's < .05).
Low BMD treatment decisions in AN may be optimized by considering both DXA and TBS results.
神经性厌食症（AN）患者的骨密度（BMD）较低，骨折风险增加。对于年轻的 AN 患者，是否应该根据异常的双能 X 射线吸收法（DXA）评分进行药物治疗，还是应该先体重恢复，然后再进行评估，目前存在争议。TBS（一种衡量骨质量的技术）与 DXA 一起使用。本报告探讨了 TBS 在严重 AN 成人中的潜在附加价值，以增加 DXA 诊断信息。
重新分析了 71 例 DXA 扫描，以获取来自患者的 TBS 结果（平均年龄：36.3 岁）。报告了实验室、人体测量值和同时进行的 DXA 测量值与 TBS 结果之间的差异。
对于该队列，平均体重指数（BMI）为 13.6 kg/m²（标准差：2.1）。绝大多数患者的 TBS 正常，平均为 1.395（标准差：0.08），但大多数患者（69%）的平均 DXA 骨密度 Z 评分异常为-2.2（标准差：1.2）。与 TBS 正常的患者相比，TBS 显示骨质量下降的患者的理想体重百分比明显更低，碱性磷酸酶水平更高（p 值均<.05）。
在 AN 中，通过考虑 DXA 和 TBS 的结果，可以优化低 BMD 的治疗决策。
