Brooks E R, Ogden B W, Cavalier D S
Woman's Health Research Institute, Woman's Hospital, Baton Rouge, Louisiana, USA.
J Womens Health. 1998 Jun;7(5):567-74. doi: 10.1089/jwh.1998.7.567.
This investigation evaluated bone density in 36 premenopausal women (mean +/- SD age = 29.5 +/- 8.4 years) an average of 11.4 years after diagnosis for anorexia nervosa. Twenty-nine women were aged 20-45 years, and seven were aged 16-19 years. Body composition, age of menarche, length of amenorrhea, estrogen exposure, and lumbar spine and proximal femur bone density were determined. Average appendicular bone density for those > or = 20 years was found to meet World Health Organization T score criteria for osteopenia: total femur T = -1.22 and femoral neck T = -1.33. The average total lumbar Z score for all 36 participants was -0.95, which was 90% of the mean for their age, and the mean Z scores for adolescent subjects were within 91% of the mean for their age (Z = -0.84). Years of estrogen exposure were correlated with lumbar mineral content (r = 0.50, p = 0.002). A modest but significant inverse relationship was observed between length of amenorrhea and femoral and lumbar bone density. The total proximal femur and trochanteric bone densities were best predicted, using stepwise regression, by the number of years after diagnosis and years of amenorrhea, respectively (R2 = 0.23, p = 0.02 and R2 = 0.21, p = 0.04). Lumbar density was best predicted by years of amenorrhea and current percent of ideal body weight (%IBW)(R2 = 0.25, p = 0.02). Length of amenorrhea, estrogen exposure, and %IBW independently contribute to axial and appendicular bone density. Because of risk for compromised bone density, women with a history of anorexia nervosa should be followed longitudinally to maximize premenopausal bone replacement.
本研究评估了36名绝经前女性（平均年龄±标准差=29.5±8.4岁）在神经性厌食症诊断后平均11.4年的骨密度。29名女性年龄在20 - 45岁之间，7名女性年龄在16 - 19岁之间。测定了身体成分、初潮年龄、闭经时长、雌激素暴露情况以及腰椎和股骨近端的骨密度。发现年龄≥20岁者的平均四肢骨密度符合世界卫生组织骨质减少的T评分标准：全股骨T值=-1.22，股骨颈T值=-1.33。36名参与者的平均腰椎Z评分为-0.95，为其年龄均值的90%，青少年受试者的平均Z评分在其年龄均值的91%以内（Z=-0.84）。雌激素暴露年限与腰椎矿物质含量相关（r=0.50，p=0.002）。闭经时长与股骨和腰椎骨密度之间存在适度但显著的负相关关系。使用逐步回归法，分别根据诊断后的年数和闭经年数能最好地预测股骨近端和转子骨的总骨密度（R2=0.23，p=0.02和R2=0.21，p=0.04）。闭经年数和当前理想体重百分比（%IBW）能最好地预测腰椎密度（R2=0.25，p=0.02）。闭经时长、雌激素暴露情况和%IBW独立影响轴向和四肢骨密度。由于存在骨密度受损的风险，有神经性厌食症病史的女性应进行纵向随访，以最大程度地促进绝经前的骨质替代。
