Effect of anorexia nervosa on bone metabolism
Authors:
Čagalová Alžbeta 1; Tichá Ubica 1; Killinger Zdenko 2; Podracká Udmila 1
Authors place of work:
Detská klinika LF UK a Národný ústav detských chorôb, Bratislava
1; V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava
2
Published in the journal:
Clinical Osteology 2020; 25(1): 37-43
Category:
Summary
Anorexia nervosa is the third most common chronic illness in adolescent girls. Clinical symptoms develop most frequently during sexual maturity. It is a period, when deprivation of nutrients with hormonal dysregulation can disrupt bone formation with microarchitectonic and structural changes and decrease bone mineral density. Objective: The aim of this study was to evaluate bone metabolism and hormonal changes in girls with anorexia nervosa. Patients and methods: There were 65 girls with anorexia nervosa between 10–18 years of age enrolled in this study. We divided the patients into 2 groups: Z-score BMI > -2 SD (A), Z-score BMI ≤ -2 SD (B). We evaluated disease and amenorrhea duration, body mass index, hormonal profile and bone metabolism parameters. We examined the bone mineral density using dual X-ray absorptiometry. The results were evaluated using mathematical – statistical methods. Results: In the lower weight group (B) were significantly lower serum concentration of phosphorus, gonadotropins (LH, FSH), estradiol and IGF-1 and higher serum cortisol concentration, as well as significantly higher calciuria. Bone formation markers (PINP 1) as well as bone turnover marker – osteocalcin were significantly lower in girls with Z-score BMI ≤ -2 SD, while bone resorption marker – CTx did not differ between groups. Bone mineral density was decreased in 14 (21.5 %) of anorectic girls. Predictor of low spinal bone mineral density was duration of secondary amenorrhea. Conclusion: Nutritional deficiency in anorexia nervosa alters neuroendocrine pathways that negatively affect bone tissue and suggest a unique osteopathic condition in anorexia nervosa patients.
Keywords:
anorexia nervosa – bone metabolism – bone mineral density – children – Hormones
Zdroje
Tichá Ľ, Payer J, Killinger Z et al. Porucha kostného metabolizmu pri mentálnej anorexii. [Impaired bone metabolism in anorexia nervosa]. Čes-Slov Pediat 2016; 71(5–6): 287–292.
Tichá Ľ, Hornová J, Birčák J. Mentálna anorexia a jej dôsledky v pediatrickej praxi. Pediatr Prax 2009; 10(2): 81–83.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association Publishing: Washington, DC. 2013. ISBN 978-0-89042-555-8.
Tichá Ľ, Payer J, Killinger Z et al. Liečebné stratégie na optimalizáciu kostného metabolizmu pri mentálnej anorexii. Čes-Slov Pediat 2017; 72(4): 223–227.
Soyka LA, Grinspoon S, Levitsky LL et al. The Effects of Anorexia Nervosa on Bone Metabolism in Female Adolescents. J Clin Endocrinol Metab 1999; 84(12): 4489–4496. Dostupné z DOI: <http://dx.doi.org/10.1210/jcem.84.12.6207>.
Ševčíková Ľ, Hamade J, Nováková J et al. Rast a vývojové trendy slovenských detí a mládeže za posledných 10 rokov. In: Ághová L. Životné podmienky a zdravie. Úrad verejného zdravotníctva SR: Bratislava 2004: 192–207. ISBN 80–7159–146–7.
Baim S, Leonard MB, Bianchi ML et al. Position Statement Official Positions of the International Society for Clinical Densitometry and Executive Summary of the 2007 ISCD Pediatric Position Development Conference. J Clin Desitom 2008; 11(1): 75–91. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jocd.2007.12.007>.
Misra M, Aggarwal A, Miller K et al. Effects of Anorexia Nervosa on Clinical, Hematologic, Biochemical, and Bone Density Parameters in Community-Dwelling Adolescent Girls. Pediatrics 2004; 114(6): 1574–1583. Dostupné z DOI: <http://dx.doi.org/10.1542/peds.2004–0540>.
Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 2nd ed. Johns Hopkins University Press: Baltimore 2010: 144–155. ISBN 10: 0801893690 .
Lindsey RC, Mohan S. Skeletal effects of growth hormone and insulin-like growth factor-I therapy. Mol Cell Endocrinol 2016; 432: 44–55. Dostupné z DOI: <http://dx.doi.org/10.1016/j.mce.2015.09.017>.
Soyka LA, Misra M, Frenchman A et al. Abnormal Bone Mineral Accrual in Adolescent Girls with Anorexia Nervosa. J Clin Endocrinol Metab 2002; 87(9): 4177–4185. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2001–011889>.
Misra M, Klibanski A. Bone metabolism in adolescents with anorexia nervosa. J Endocrinol Invest 2011; 34(4): 324–332. Dostupné z DOI: <http://dx.doi.org/10.1007/BF03347094>.
Mora S, Pitukcheewanont P, Kaufman FR et al. Biochemical markers of bone turnover and the volume and the density of bone in children at different stages of sexual development. J Bone Miner Res 1990; 14(10): 1664–1671. Dostupné z DOI: <http://dx.doi.org/10.1359/jbmr.1999.14.10.1664>.
Misra M, Miller K, Almazan C et al. Alterations in Cortisol Secretory Dynamics in Adolescent Girls with Anorexia Nervosa and Effects on Bone Metabolism. J Clin Endocrinol Metab 2004; 89(10); 4972–4980. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2004–0723>.
Holick MF, Binkley NC, Bischoff-Ferrari HA et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2011; 96(7): 1911–1930. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2011–0385>.
Abrams SA, Silber TJ, Esteban NV et al. Mineral balance and bone turnover in adolescents with anorexia nervosa. J Pediatr 1993; 123(2): 326–331. Dostupné z DOI: <http://dx.doi.org/10.1016/s0022–3476(05)81714–7>.
Audí L, Vargas DM, Gussinyé M et al. Clinical and biochemical determinants of bone metabolism and bone mass in adolescent female patients with anorexia nervosa. Pediatr Res 2002; 51(4): 497–504. Dostupné z DOI: <http://dx.doi.org/10.1203/00006450–200204000–00016>.
Salisbury JJ, Mitchell JE. Bone mineral density and anorexia nervosa in women. Am J Psychiatry 1991; 148(6): 768–774. Dostupné z DOI: <http://dx.doi.org/10.1176/ajp.148.6.768>.
Payer J, Dimová N, Killinger Z et al. Kostná denzita u pacientok s mentálnou anorexiou. Čes slov Psychiatr 1997; 93: 189–192.
Castro J, Lázaro L, Pons F et al. Predictors of Bone Mineral Density Reduction in Adolescents With Anorexia Nervosa. J Am Acad Child Adolesc Psychiatry 2000; 39(11): 1365–1370. Dostupné z DOI: <http://dx.doi.org/10.1097/00004583–200011000–00010>
Blumsohn A, Hannon R, Erate R et al. Biochemical markers of bone turnover in girls during puberty. Clin Endocrinol 1994; 40(5); 663–670. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1365–2265.1994.tb03019.x>.
Štítky
Clinical biochemistry Paediatric gynaecology Paediatric radiology Paediatric rheumatology Endocrinology Gynaecology and obstetrics Internal medicine Orthopaedics General practitioner for adults Radiodiagnostics Rehabilitation Rheumatology Traumatology OsteologyČlánok vyšiel v časopise
Clinical Osteology
2020 Číslo 1
- Advances in the Treatment of Myasthenia Gravis on the Horizon
- Memantine Eases Daily Life for Patients and Caregivers
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
Najčítanejšie v tomto čísle
- Atypical cases of secondary hyperparathyroidism in patients with kidney disease and failure: case reports
- Guidelines for osteoporotic patients during COVID-19 pandemics
- Effect of anorexia nervosa on bone metabolism
- Management of osteoporosis and calcium metabolism disorders during COVID-19 pandemics