Jensen L B, Quaade F, Sørensen O H
Osteoporosis Research Centre, Copenhagen Municipal Hospital, Denmark.
J Bone Miner Res. 1994 Apr;9(4):459-63. doi: 10.1002/jbmr.5650090404.
Dual-energy x-ray absorptiometry was performed in 51 obese patients before and after 15 weeks on a low-calorie diet. Of these patients 39 were scanned 6 months later. Total and regional body bone mineral, fat mass, and fat free mass were measured. In the control group, 9 normal volunteers were scanned with up to 23 kg lard distributed anteriorly, and 9 volunteers were scanned with 15 kg lard posteriorly. The lard was then gradually removed to simulate the fat loss found in the patient group. In the patient group the mean weight loss was 12,273 g, the mean fat loss was 11,014 g, and the mean bone mineral loss was 171.6 g after 15 weeks. Close correlation between the fat loss and the bone loss was found and calculated to be 16.5 g bone mineral per kg fat in the patient group, in contrast with 0.5 g bone mineral per kg fat in the control group. In the control group, 15 kg lard placed posteriorly had no statistically significant effect on the bone measurements. If weight and fat were regained at the scanning time 6 months later, the bone mineral was regained as well. Patients with further weight loss continued to lose bone mineral. One patient lost 754 g bone mineral in 9 months. Her weight loss was 45 kg in that period, and the bone mineral content remained within the range for normal women at her age. Methodologic and pathogenetic problems are discussed. It is concluded that the observed bone loss should be regarded as physiologic normalization accompanying a diet-induced weight loss in the obese.
对51名肥胖患者在进行15周低热量饮食前后进行了双能X线吸收测定。其中39名患者在6个月后进行了扫描。测量了全身和局部的骨矿物质、脂肪量和去脂体重。在对照组中，对9名正常志愿者进行扫描，在其身体前部放置多达23千克猪油，对另外9名志愿者在身体后部放置15千克猪油。然后逐渐去除猪油以模拟患者组中出现的脂肪减少情况。在患者组中，15周后平均体重减轻12273克，平均脂肪减少11014克，平均骨矿物质减少171.6克。发现脂肪减少与骨质流失之间存在密切相关性，经计算患者组中每千克脂肪导致的骨矿物质流失为16.5克，而对照组中每千克脂肪导致的骨矿物质流失为0.5克。在对照组中，在身体后部放置15千克猪油对骨测量结果无统计学显著影响。如果在6个月后的扫描时体重和脂肪恢复，骨矿物质也会恢复。体重进一步减轻的患者继续流失骨矿物质。一名患者在9个月内流失了754克骨矿物质。在此期间她体重减轻了45千克，其骨矿物质含量仍处于同龄正常女性的范围内。文中讨论了方法学和发病机制问题。得出的结论是，观察到的骨质流失应被视为肥胖者因饮食导致体重减轻而伴随的生理性恢复正常的过程。
