神経性食欲不振症における骨粗鬆症の病態と治療

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Anorexia nervosa (AN) patients frequently present with accompanying osteoporosis. There is a significant correlation between the spinal bone mineral density (BMD) evaluated by dual X-ray absorptiometry and duration of emaciation below a body mass index (BMI) of 15 kg/m^2. Body weight history is the most important predictor of the presence of osteoporosis as well as recovery. The increase in BMD per year significantly correlates with the initial BMI in AN patients. The critical BMI for a positive increase in BMD is 16.4±0.3 kg/m^2. The BMD in some AN patients does not increase to the normal range even several years after the recovery from AN. Osteoporosis in AN patients involves both a reduction in bone formation and an increase in bone resorption. The changes in bone metabolic markers are dependent upon BMI. The bone formation marker, serum osteocalcin, significantly and positively correlates with both BMI and serum levels of insulin-like growth factor-I (IGF-I). IGF-I is a useful nutritional parameter and an osteoanabolic growth factor. Serum estradiol levels showed a positive correlation with BMI. The minimum serum estradiol level required for suppression of bone resorption marker is between 1.36 and 3 pg/mL. Body weight gain is the most effective way to increase BMD in AN patients. The treatment with calcium and 1α (OH) vitamin D3 prevent bone loss in AN patients. Estrogen replacement therapy prevents bone loss only in severely emaciated AN patients. It is difficult for AN patients to accept weight gain. However, AN patients should be given precise and detail information about osteoporosis in an effort to educate them about the impaired quality of life that may be induced as one of the most severe complication of AN.
東京女子医科大学の論文
2002-01-25

神経性食欲不振症における骨粗鬆症の病態と治療

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