Clinical Nutrition unit, Paul Brousse University Hospital (AP-HP), Villejuif, France.
GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, Paris, France.
Clin Endocrinol (Oxf). 2021 Sep;95(3):423-429. doi: 10.1111/cen.14498. Epub 2021 May 30.
Low bone mineral density (BMD) is a frequent and invalidating consequence of chronic undernourishment in patients with anorexia nervosa (AN). The aim of this study was to assess prevalence and clinic-biological correlates of low BMD and fractures in extremely undernourished inpatients with AN.
Retrospective cohort study.
This study included 97 extremely malnourished female inpatients with AN consecutively admitted over 2 years. Clinical-biological variables, history of fractures and BMD by dual-energy X-ray absorptiometry (DXA) were examined to find predictors of low BMD and fractures.
The prevalence of low BMD was of 51% for lumbar spine and 38% for femoral neck. Z-scores were lower at lumbar spine (-2.2 ± 1.2 SD) than at femoral neck (-1.9 ± 0.9 SD) (P<.01). Fragility fractures were reported by 10% of patients. BMD was mainly predicted by FFM, illness duration, age at onset and restricting AN (P<.05). Fractures were predicted by sodium concentrations, femoral neck Z-score and illness duration (P<.03).
Extremely severe patients with AN have high prevalence of low BMD, predicted by severity and chronicity of malnutrition.
低骨密度（BMD）是神经性厌食症（AN）患者慢性营养不良的常见且致残后果。本研究旨在评估极度营养不良的 AN 住院患者低 BMD 和骨折的患病率及临床生物学相关性。
回顾性队列研究。
本研究纳入了 2 年内连续收治的 97 名极度营养不良的女性 AN 住院患者。检查了临床生物学变量、骨折史和双能 X 线吸收法（DXA）的 BMD，以寻找低 BMD 和骨折的预测因素。
腰椎的低 BMD 患病率为 51%，股骨颈为 38%。腰椎处的 Z 分数（-2.2±1.2 SD）低于股骨颈处（-1.9±0.9 SD）（P<.01）。10%的患者报告有脆性骨折。FFM、病程、发病年龄和限制型 AN 主要预测 BMD（P<.05）。骨折主要由血清钠浓度、股骨颈 Z 分数和病程预测（P<.03）。
患有严重 AN 的极度严重患者存在低 BMD 的高患病率，这可由营养不良的严重程度和慢性程度来预测。
