{"title":"神经性厌食症的低骨密度:治疗和挑战。","authors":"Pouneh K Fazeli","doi":"10.1007/s12018-019-09260-4","DOIUrl":null,"url":null,"abstract":"<p><p>Anorexia nervosa, a psychiatric disease predominantly affecting women, is characterized by self- induced starvation and a resultant low-weight state. During starvation, a number of hormonal adaptations - including hypothalamic amenorrhea and growth hormone resistance - allow for decreased energy expenditure during periods of decreased nutrient intake, but these very same adaptations also contribute to the medical complications associated with chronic starvation, including low bone mass. Almost 90% of women with anorexia nervosa have bone mineral density (BMD) values more than one-standard deviation below the mean of healthy women at peak bone mineral density and this disease is associated with a significantly increased risk of fracture. Although multiple therapies have been studied for the treatment of low bone mass in anorexia nervosa, there are currently no approved therapies and few promising long-term therapeutic options. This review will outline the mediators of low bone mass in anorexia nervosa, discuss therapies that have been studied for the treatment of low BMD in this disorder, and highlight the important challenges that remain, including the differences in bone modeling in adolescents with anorexia nervosa as compared to adults, necessitating that potential therapies be tested in these two populations separately, and the paucity of long-term therapeutic strategies for treating bone loss in this disorder.</p>","PeriodicalId":45316,"journal":{"name":"Clinical Reviews in Bone and Mineral Metabolism","volume":null,"pages":null},"PeriodicalIF":0.8000,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12018-019-09260-4","citationCount":"14","resultStr":"{\"title\":\"Low bone mineral density in anorexia nervosa: Treatments and challenges.\",\"authors\":\"Pouneh K Fazeli\",\"doi\":\"10.1007/s12018-019-09260-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Anorexia nervosa, a psychiatric disease predominantly affecting women, is characterized by self- induced starvation and a resultant low-weight state. During starvation, a number of hormonal adaptations - including hypothalamic amenorrhea and growth hormone resistance - allow for decreased energy expenditure during periods of decreased nutrient intake, but these very same adaptations also contribute to the medical complications associated with chronic starvation, including low bone mass. Almost 90% of women with anorexia nervosa have bone mineral density (BMD) values more than one-standard deviation below the mean of healthy women at peak bone mineral density and this disease is associated with a significantly increased risk of fracture. Although multiple therapies have been studied for the treatment of low bone mass in anorexia nervosa, there are currently no approved therapies and few promising long-term therapeutic options. This review will outline the mediators of low bone mass in anorexia nervosa, discuss therapies that have been studied for the treatment of low BMD in this disorder, and highlight the important challenges that remain, including the differences in bone modeling in adolescents with anorexia nervosa as compared to adults, necessitating that potential therapies be tested in these two populations separately, and the paucity of long-term therapeutic strategies for treating bone loss in this disorder.</p>\",\"PeriodicalId\":45316,\"journal\":{\"name\":\"Clinical Reviews in Bone and Mineral Metabolism\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2019-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1007/s12018-019-09260-4\",\"citationCount\":\"14\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Reviews in Bone and Mineral Metabolism\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s12018-019-09260-4\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2019/4/15 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Reviews in Bone and Mineral Metabolism","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12018-019-09260-4","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2019/4/15 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Low bone mineral density in anorexia nervosa: Treatments and challenges.
Anorexia nervosa, a psychiatric disease predominantly affecting women, is characterized by self- induced starvation and a resultant low-weight state. During starvation, a number of hormonal adaptations - including hypothalamic amenorrhea and growth hormone resistance - allow for decreased energy expenditure during periods of decreased nutrient intake, but these very same adaptations also contribute to the medical complications associated with chronic starvation, including low bone mass. Almost 90% of women with anorexia nervosa have bone mineral density (BMD) values more than one-standard deviation below the mean of healthy women at peak bone mineral density and this disease is associated with a significantly increased risk of fracture. Although multiple therapies have been studied for the treatment of low bone mass in anorexia nervosa, there are currently no approved therapies and few promising long-term therapeutic options. This review will outline the mediators of low bone mass in anorexia nervosa, discuss therapies that have been studied for the treatment of low BMD in this disorder, and highlight the important challenges that remain, including the differences in bone modeling in adolescents with anorexia nervosa as compared to adults, necessitating that potential therapies be tested in these two populations separately, and the paucity of long-term therapeutic strategies for treating bone loss in this disorder.
期刊介绍:
Clinical Reviews in Bone and Mineral Metabolism is an international review journal aimed at integrating new information from both basic and clinical science into the context of clinical practice in the wide field of Bone and Mineral Metabolism. Although one purpose of the journal is to deal with the well-known classical aspects of bone and mineral physiology, the journal’s unique character is to highlight information about the advancing field of molecular medicine, which now finds linkages between this classical field and disease states that in the past were considered distinct. For example, cardiovascular disease and osteoporosis share many biochemical pathways. New molecular tools show common pathways with bone physiology and obesity, diabetes mellitus, and energy metabolism. The focus on the novel is a major aspect of this journal’s purpose. The rapid developments in the field needs to be represented in a comprehensive way in order to keep students, clinicians and researchers up-to date. In order to assure that all latest developments are covered, the journal publishes, not only, unsolicited reviews, but also invited reviews on most important topics as well.