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Painon ja kuukautiskierron sekä luuntiheyden palautuminen

Näytönastekatsaukset
Laure Morin-Papunen
17.9.2014

Näytön aste: B

Painon ja kuukautiskierron palautuminen lienevät tärkeimmät tekijät luuntiheyden palautumisen kannalta.

This prospective observational study «Misra M, Prabhakaran R, Miller KK ym. Weight gain ...»1 assessed the effect of recovery from anorexia nervosa (AN) on bone density measures and on height-adjusted bone density measures, menstrual recovery and weight gain (10 % or more increase in body mass index) were hypothesized to predict an increase in these measures of bone density. Patients and methods: Lumbar and whole-body (WB) bone density was measured at 0, 6, and 12 months in 34 AN girls aged 12–18 yr and 33 controls. Results: Girls with AN had lower spine bone mineral content (BMC), compared with controls. Menstrual recovery and weight gain in AN (AN-recovered) (median 9 months) resulted in a stabilization of BMD measures, whereas BMD continued to decrease in AN who did not gain weight and recover menses (AN-not recovered). AN-recovery also predicted greater increases in spine BMC compared with AN-not recovered (P < 0.05). Conclusions: Even short-term weight gain with menstrual recovery is associated with a stabilization of BMD measures.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: hyvä

This article «Misra M, Klibanski A. Anorexia nervosa and osteopo...»2 reviews the pathophysiology of low bone mineral density (BMD) in adults and adolescents with anorexia nervosa (AN). Whereas adult women with AN have an uncoupling of bone turnover markers with increased bone resorption and decreased bone formation markers, adolescents with AN have decreased bone turnover overall. Possible contributors to low BMD in AN include hypoestrogenism and hypoandrogenism, undernutrition with decreased lean body mass, and hypercortisolemia. IGF-I, a known bone trophic factor, is reduced despite elevated growth hormone (GH) levels, leading to an acquired GH resistant state. Elevated ghrelin and peptide YY levels may also contribute to impaired bone metabolism. Weight recovery is associated with recovery of BMD but this is often partial, and long-term and sustained weight recovery may be necessary before significant improvements are observed. Anti-resorptive therapies have been studied in AN with conflicting results. Oral estrogen does not increase BMD or prevent bone loss in AN. The combination of bone anabolic and anti-resorptive therapy (rhIGF-I with oral estrogen), however, did result in a significant increase in BMD in a study of adult women with AN. A better understanding of the pathophysiology of low BMD in AN, and development of effective therapeutic strategies is critical. This is particularly so for adolescents, who are in the process of accruing peak bone mass, and in whom a failure to attain peak bone mass may occur in AN in addition to loss of established bone.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: hyvä

The objective of this longitudinal study «Miller KK, Lee EE, Lawson EA ym. Determinants of s...»3 was to determine the rate of bone loss at the spine and hip in women with anorexia nervosa (AN) and whether resumption of menstrual function and/or improvement in weight are determinants of skeletal recovery in AN. Patients: Participants included 75 ambulatory women with AN. Outcome measures: Bone mineral density (BMD) and body composition were measured with dual x-ray absorptiometry. Results: In women not receiving oral contraceptives, those who did not improve weight or resume menses had a mean annual rate of decline of 2.6 % at the spine and 2.4 % at the hip. Those who resumed menses and improved weight had a mean annual increase of 3.1 % at the posteroanterior spine and 1.8 % at the hip. Women who improved weight, regardless of whether they recovered menstrual function, demonstrated a mean increase of hip, but not spine, BMD. Increase in fat-free mass was a more significant determinant of increased BMD than weight or fat mass gain. In women receiving oral contraceptives, there was no increase in BMD at any site despite a mean 11.7 % weight increase. Conclusions: These data suggest that rapid bone loss, at an average annual rate of about 2.5 %, occurs in young women with active AN. Resumption of menstrual function is important for spine BMD recovery, whereas weight gain is critical for hip BMD recovery. No increase in BMD with weight gain in women receiving oral contraceptives was observed. Therefore, improvements in reproduction function and weight, with increases in lean body mass a critical component, are both necessary for skeletal recovery in women with AN.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

The purpose of this longitudinal study «Legroux-Gerot I, Vignau J, Collier F ym. Factors i...»4 was to evaluate factors affecting changes in bone mineral density (BMD) in patients with anorexia nervosa (AN) and osteoporosis and, more particularly, to assess the benefits of hormone replacement therapy (HRT) on BMD in these patients. The study involved 45 AN patients, 12 of whom had been treated by HRT for 2 years following a diagnosis of osteoporosis by densitometry (WHO criteria). Patients' mean age was 25.3 +/- 6.7 years. Mean duration of illness was 5.7 +/- 5.3 years. Serum calcium and phosphate were measured at baseline, as were bone remodeling markers. Osteodensitometry by dual-energy X-ray absorptiometry was performed at inclusion and after 2 years. After 2 years, no significant differences were observed between spine, femoral neck, and total hip BMDs either in the HRT group or in the nontreatment group. Moreover, there were no significant differences between the two groups when changes in spine, femoral neck, and total hip BMDs at 2 years were compared. In both groups, change in weight at 1 year correlated with change in spine BMD at 2 years and change in total-hip BMD at 2 years but not with change in femoral neck BMD at 2 years. Patients with a body mass index (BMI) 17 kg/m2 at 2 years showed a significant increase in total-hip BMD when compared with patients with a BMI < 17 kg/m2. No significant differences were observed for spine and femoral neck BMD. In patients who had recovered their menstrual cycle, significant increases were observed in spine BMD, femoral neck BMD and total-hip BMD. Prevention of bone loss at 2 years in AN patients treated by HRT was not confirmed in this study. We did confirm that increase in weight at 1 year was the most predictive factor for the improvement of spine and hip BMD at 2 years.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: hyvä

Kommentit

Painon ja kuukautiskierron palautumisen vaikutusta ei voida tutkia RCT-asetelmassa.

Kirjallisuutta

  1. Misra M, Prabhakaran R, Miller KK ym. Weight gain and restoration of menses as predictors of bone mineral density change in adolescent girls with anorexia nervosa-1. J Clin Endocrinol Metab 2008;93:1231-7 «PMID: 18089702»PubMed
  2. Misra M, Klibanski A. Anorexia nervosa and osteoporosis. Rev Endocr Metab Disord 2006;7:91-9 «PMID: 16972186»PubMed
  3. Miller KK, Lee EE, Lawson EA ym. Determinants of skeletal loss and recovery in anorexia nervosa. J Clin Endocrinol Metab 2006;91:2931-7 «PMID: 16735492»PubMed
  4. Legroux-Gerot I, Vignau J, Collier F ym. Factors influencing changes in bone mineral density in patients with anorexia nervosa-related osteoporosis: the effect of hormone replacement therapy. Calcif Tissue Int 2008;83:315-23 «PMID: 18836675»PubMed