Katsausartikkeleissa «Becker AE, Grinspoon SK, Klibanski A ym. Eating disorders. N Engl J Med 1999;340:1092-8 »1 suositellaan kalsiumin (1 000–1 500 mg/vrk) ja D-vitamiininin (400–500 kY/vrk) käyttöä estrogeenikorvaushoidon lisäksi luukadon estämiseksi, vaikka selkää näyttöä asiasta RCT asetelmissä ei ole.

• Tutkimuksen laatu: kelvollinen
• Sovellettavuus suomalaiseen väestöön: hyvä

This article «Misra M, Klibanski A. Anorexia nervosa and osteoporosis. Rev Endocr Metab Disord 2006;7:91-9 »2 reviewed the mechanisms associated with 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

Lumekontrolloitussa satunnaistetussa tutkimuksiessa «Nakahara T, Nagai N, Tanaka M ym. The effects of bone therapy on tibial bone loss in young women with anorexia nervosa. Int J Eat Disord 2006;39:20-6 »3 kolmen kuukauden kalsiumi-D-vitamiini yhdistelmä oli yhtä tehokas kuin etidronaatti sääriluun luutiheyden säilyttämiseksi.

A randomized placebo-controlled study of the effects of etidronate and calcium (600mg/d) and vitamin D (1 microg/d) on bone loss was conducted in 41 outpatients with the restricting type of anorexia nervosa. Intervention: measure of the tibial speed of sound (SOS) before and after 3 months of treatment. Outcome: The bone mineral density (BMD) of the tibial SOS change in both the etidronate group(n=14) and the calcium and vitamin D group (n=15) was significantly greater (p < .001) than in the control placebo group (n=12). Urine-N-telopeptide cross-links of type I collagen (NTx) before and after treatment decreased significantly (p < .01) in the etidronate group. Conclusion: These findings suggest that both etidronate and calcium and vitamin D are equally efficacious for reversing the degree of osteoporosis in patients with anorexia nervosa.

• Tutkimuksen laatu: heikko
• Sovellettavuus suomalaiseen väestöön: hyvä