Bone mineral content and bone mineral density in adolescent girls with anorexia nervosa--a longitudinal study

OBJECTIVE: Total body and lumbar spine bone mineral density (BMD-TB, BMD-L) and total body bone mineral content (BMC-TB) were measured to establish the course of bone demineralization in anorexia nervosa and the clinical factors influencing BMC-TB and BMD changes during treatment. METHOD: Forty-two girls with DSM III-R anorexia nervosa, age 14.7+/-2.4 years. BMC-TB, BMD-TB and BMD-L were measured in approximately 7-month intervals for 27.8+/-4.1 months using DXA. RESULTS: Despite nutritional improvement, there was an initial decrease of BMD-L, and no change in BMC-TB and BMD-TB. an increase in BMC-TB and BMD was observed after approx. 21 months from the beginning of the study. CONCLUSION: The improvement in BMC-TB and BMD was related to changes in nutritional status and was significantly marked in younger patients, with earlier anorexia onset and before menarche.     

A cross-sectional and follow-up voxel-based morphometric MRI study in adolescent anorexia nervosa

The objective was to examine whether cerebral volumes are reduced, and in what regions, in adolescents with anorexia nervosa and to study changes after nutritional recovery. Twelve anorexia nervosa (DSM-IV) patients aged 11-17 consecutively admitted to an Eating Disorders Unit were assessed by means of psychopathological scales, neuropsychological battery and voxel-based morphometric (VBM) magnetic resonance imaging at admission and after 7 months’ follow-up. Nine control subjects of similar age, gender and estimated intelligence level were also studied. The two groups showed differences in gray matter (F = 22.2; p < 0.001) and cerebrospinal fluid (CSF) (F = 21.2; p < 0.001) but not in white matter volumes. In anorexic patients, gray matter volume correlated negatively with the copy time from the Rey Complex Figure Test. In the regional VBM study several temporal and parietal gray matter regions were reduced. During follow-up there was a greater global increase in gray matter (F = 10.7; p = 0.004) and decrease in CSF (F = 22.1; p = 0.001) in anorexic patients. The increase in gray matter correlated with a decrease in cortisol (Spearman correlation = −0.73; p = 0.017). At follow-up there were no differences in global gray matter (F = 2.1; p = 0.165), white matter (F = 0.02, p = 0.965) or CSF (F = 1.8; p = 0.113) volumes between both groups. There were still some smaller areas, in the right temporal and both supplementary motor area, showing differences between them in the regional VBM study. In conclusion, in adolescent anorexic patients gray matter is more affected than white matter and mainly involves the posterior regions of the brain. Overall gray matter alterations are reversible after nutritional recovery.     

泌乳素型垂体腺瘤患者的骨密度研究

目的评估中国大陆泌乳素型垂体腺瘤患者的骨代谢改变并进一步分析其影响因素。方法选取2007年12月至2008年5月间于我院就诊的泌乳素型垂体腺瘤患者27例（男性10例,女性17例）和同期健康对照组228人,对其骨密度改变进行评估。依据术前的激素水平,分析泌乳素型垂体腺瘤患者术前腰椎骨密度的影响因素。结果男性和女性泌乳素型垂体腺瘤患者的骨密度均明显低于其正常对照组。单因素分析：男性患者的骨密度和睾酮含量呈正相关;女性患者的骨密度和身高呈正相关,和病程呈负相关。多因素分析：女性患者的骨密度和病程呈明显的负相关。结论泌乳素型垂体腺瘤的患者易于发生骨量减低。女性患者的骨密度改变与病程呈明显负相关。     

A cross-sectional and follow-up functional MRI study with a working memory task in adolescent anorexia nervosa

Structural and functional brain abnormalities have been described in anorexia nervosa (AN). The objective of this study was to examine whether there is abnormal regional brain activation during a working memory task not associated with any emotional stimuli in adolescent patients with anorexia and to detect possible changes after weight recovery. Fourteen children and adolescents (age range 11–18 years) consecutively admitted with DSM-IV diagnosis of AN and fourteen control subjects of similar age were assessed by means of psychopathological scales and functional magnetic resonance imaging (fMRI) during a working memory task. After seven months of treatment and weight recovery, nine AN patients were reassessed. Before treatment, the AN group showed significantly higher activation than controls in temporal and parietal areas and especially in the temporal superior gyrus during performance of the cognitive task. Control subjects did not show greater activation than AN patients in any region. A negative correlation was found between brain activation and body mass index and a positive correlation between activation and depressive symptomatology. At follow-up after weight recovery, AN patients showed a decrease in brain activation in these areas and did not present differences with respect to controls. These results show that adolescent AN patients showed hyperactivation in the parietal and especially the temporal lobe during a working memory task, suggesting that they must make an additional effort to perform at normal levels. This activation correlated with clinical variables. In these young patients, differences with respect to controls disappeared after weight recovery.     

A 2-year prospective study of bone metabolism and bone mineral density in adolescents with anorexia nervosa

Summary Osteopenia and osteoporosis are complications of adolescent anorexia nervosa (AN) and may result in a permanent deficit of bone mass in adulthood. It is still unclear if a complete catch-up in bone mineral density (BMD) is possible after weight rehabilitation in AN. Methods. We investigated bone formation (bAP, PICP), bone resorption (CTX) and BMD (lumbar spine, femoral neck) along with endocrinological parameters in 19 girls with AN (14.4 ± 1.6 years) and in 19 healthy controls for 2 years after inpatient re-feeding. Results. Re-feeding normalised bone formation activity in patients. The pattern of bone turnover in patients after 2 years was similar to the pattern healthy controls had shown 2 years before. BMD of patients was significantly lower than in controls and did not change throughout the entire study. Conclusions. Weight rehabilitation leads to prolonged normalization of bone turnover in adolescent AN. Since we could not observe a “catch up” effect in BMD of girls with AN in a 2-year follow-up, BMD of these patients needs to be carefully monitored until adulthood to detect early osteoporosis. The first two authors contributed equally     

Handedness related differences in bone mineral density in patients with osteoporosis

ObjectiveLeft-handedness was reported to be associated with lower bone mineral density in a recent study and also to be a risk factor for accident-related injuries, head injuries, traumatic brain injuries, sport-related injuries and bone breaks and fractures. Therefore, the bone mineral densities of 17 left-handed patients with osteoporosis were compared to those of 141 right-handed ones in 14 males and 144 females.MethodsHand preference was assessed using the Edinburgh Handedness Inventory. To measure the bone mineral density, a Hologic QDR-4500W (S/N 48403) densitometer was used. Multivariate analysis of variance was used for the statistical evaluation.ResultsThe bone mineral densities were higher in the right-handed patients with osteoporosis than in the left-handed ones.ConclusionsThese results support the claim that the left-handed patients with osteoporosis had higher bone damage risk in traumas and accidents.     

Bone mineral density in children, adolescents, and young adults with epilepsy

Purpose:   The aim of this study was to assess bone mineral density (BMD) in a large population of children, adolescents, and young adults with epilepsy alone or in association with cerebral palsy and/or mental retardation.
Methods:   Ninety-six patients were enrolled in the study. The group comprised 50 males and 46 females, aged between 3 and 25 years (mean age 11 years). The control group consisted of 63 healthy children and adolescents (23 males, 40 females), aged between 3 and 25 years (mean age 12.1 years). Patients underwent a dual-energy x-ray absorptiometry (DEXA) scan of the lumbar spine (L1–L4) and the z scores were calculated for each patient; the t score was considered for patients 18 years of age or older.
Results:   Abnormal BMD was found in 56 patients (58.3%), with values documenting osteopenia in 42 (75%) and osteoporosis in 14 (25%). A significant difference emerged between epileptic patients and the control group in BMD, z score, and body mass index (BMI) (p = <0.001). Lack of autonomous gait, severe mental retardation, long duration of antiepileptic treatment, topiramate adjunctive therapy, and less physical activity significantly correlated with abnormal BMD.
Discussion:   This study detected abnormal BMD in more than half of a large pediatric population with epilepsy with or without cerebral palsy and/or mental retardation. The clinical significance of these findings has yet to be clarified.     

A retrospective study of SSRI treatment in adolescent anorexia nervosa: insufficient evidence for efficacy

Although selective-serotonin-reuptake-inhibitors (SSRI) have been of limited efficacy in the treatment of eating disorder psychopathology and comorbid symptoms of malnourished patients with anorexia nervosa (AN), there is recent data suggesting that SSRI may play a role in preventing relapse among weight-restored patients. Though some previous studies included patients in late adolescence, the vast majority of investigated subjects have been adults. The aim of our retrospective study was to assess the effects of SSRI treatment in partially weight-restored children and adolescents with AN. Thirty two females with AN (mean 14.5+/-1.4 years) were investigated three times during inpatient treatment and at 3- and 6-month follow-up for BMI, eating disorder psychopathology, depressive symptomology, and obsessive-compulsive symptomology. Medication history during inpatient and outpatient treatment was reconstructed at the 6-month follow-up. Nineteen patients received SSRI treatment, while 13 subjects were non-medicated. In comparison to the non-SSRI group, the SSRI group had similar BMI and obsessive-compulsive scores, but higher levels of core eating disorder psychopathology and depressive symptoms at the start of medication. Rates of re-admissions were similar in both groups (SSRI group: 36%, non-SSRI group: 31%, Phi: p=0.72). Repeated measures ANOVA revealed no significant group with time interactions for BMI-SDS (p=0.84), core eating disorder symptoms (ANIS, p=0.79), depression (DIKJ, p=0.75), and obsessive-compulsive (CY-BOCS, p=0.40) scores indicating minimal or no effects of SSRI medication on the course of these variables. In conclusion, our results challenge the efficacy of SSRI medication in the treatment of eating disorder psychopathology as well as depressive and obsessive-compulsive comorbidity in adolescent AN. Clinicians should be chary in prescribing SSRI in adolescent AN unless randomized controlled trials have proofed the benefit of these drugs.     

贵阳地区成人骨密度与骨质疏松症调查*

背景：中国很多地方做过骨密度的变化规律及骨质疏松症的调查,但对于地处西部的贵阳地区,尚缺乏对的骨密度变化规律和骨质疏松症全面系统的随机调查。 目的：调查贵阳地区成人骨密度,为该地区骨质疏松的预防、诊断、治疗提供参考依据。 方法：2008/2011用双能X射线骨密度仪对贵阳地区共1 334例年龄为20~79岁的人群进行骨密度测定,测定部位包括腰椎1~4椎体、右股骨近端,以峰值骨密度减低2. 0 SD为诊断骨质疏松症标准,按性别、10岁一个年龄分组进行统计学分析。 结果与结论：贵阳地区男、女骨密度峰值均在20~29岁年龄组,女性50岁、男性60岁以后骨密度值明显降低。20~29岁的女性人群中出现骨质疏松症发病率和骨丢失率较高的异常现象。提示对于女性小于50岁和男性小于60岁,应加强普及骨质疏松预防知识,50岁以上的女性和60岁以上的男性还应同时采取相应干预措施,以减少骨质疏松症的发生,同时该调查为贵阳地区骨质疏松症的诊治提供了参考依据。     

Prefrontal brain metabolites in short-term weight-recovered adolescent anorexia nervosa patients

Various neuroimaging techniques have revealed morphological and functional alterations in anorexia nervosa (AN), although few spectroscopic magnetic resonance studies have examined short-term weight-recovered AN patients. Subjects were 32 female adolescent patients (between 13 and 18 years old) seen consecutively in our department and who met DSM-IV diagnostic criteria for AN. All of them had received a minimum of six months of treatment and were short-term weight-recovered (for one to three months) with a body mass index ranging from 18 to 23. A group of 20 healthy female volunteer controls of similar age were also included. All subjects were assessed with psychopathological scales and magnetic resonance spectroscopy. Total choline (Cho) (p = 0.007) and creatine (Cr) (p = 0.008) levels were significantly higher in AN patients than in controls. AN patients receiving psychopharmacological treatment with SSRIs (N = 9) had metabolite levels similar to control subjects, but patients without this treatment did not. The present study shows abnormalities in brain neurometabolites related to Cho compounds and Cr in the prefrontal cortex in short-term weight-recovered adolescent AN patients, principally in patients not undergoing psychopharmacological treatment. More studies with larger samples are necessary to test the generalizability of the present results.     

无功能型垂体腺瘤患者术前骨密度的改变

目的 评估无功能型垂体腺瘤患者的骨密度改变,分析影响骨密度改变的相关因素.方法 收集2007年12月至2008年5月间于我科就诊的无功能型垂体腺瘤的患者31例和同期的健康对照组资料255例,对患者组骨密度改变进行评估.并依据患者组术前的激素水平及病程,分析引起无功能型垂体腺瘤患者骨密度改变的相关因素.结果 58%的男性和50%的女性无功能腺瘤患者出现了明显的骨密度减低.无功能腺瘤患者组和对照组骨密度Z值之间差异无统计学意义.Logistic回归分析结果显示:男性患者的骨密度下降和血清睾酮水平下降相关(x2=9.91,P＜0.01,OR=15.75).结论 无功能型垂体腺瘤患者的骨密度有下降趋势.男性患者血清睾酮水平下降是引起患者骨密度下降的相关因素.

Abstract：

Objective To evaluate the bone mineral density (BMD) alteration of patients with nonfunctional pituitary adenoma in Chinese mainland and further to investigate the relevant factors of BMD changement.Methods 31 patients with nonfunctional adenoma and 255 healthy controls were enrolled in this study between December 2007 and May 2008.The Z scores of BMD between the patients and the controls were evaluated.The hormonal activities of the preoperative patients were analyzed to reveal the influencing factors of BMD.Methods The decrease of BMD was identified in 58 percent of male and 50percent of female patients with nonfunctional adenoma.There was no statistical difference in Z score of BMD compared with controls.Logistic Regression analysis indicated that:the decreasing serum test osterone in male patients(x2 =9.91,P ＜0.01 ,OR = 15.75) was the relevant factor of the decreased BMD existed in nonfunctional adenoma patients.Conclusion There was a decreasing trend of BMD in patients with nonfunctional adenoma.The high rate of incidence of hypogonadism in male patients may be the relevant factor of the decreased BMD in patients with nonfunctional adenoma.     

Adolescent anorexia nervosa: cross-sectional and follow-up frontal gray matter disturbances detected with proton magnetic resonance spectroscopy

There are very few magnetic resonance spectroscopy studies in anorexia nervosa and none of them with young adolescent patients. We studied 12 anorexia nervosa (DSM-IV) patients aged 11-17 consecutively admitted to an Eating Disorders Unit. An evaluation with laboratory data, psychopathological scales, magnetic resonance spectroscopy ((1)H MRS) and a neuropsychological battery was carried out at admission and after 7 months' follow-up and weight recovery. Psychopathological and neuropsychological and MRS examinations were also performed in 12 control subjects. In the MRS study at the frontal gray matter, the anorexic group had a significantly lower N-acetyl-aspartate (NAA) (p = .002), glutamate/glutamine (Glx) (p = .010) and myo-Inositol (mI) (p = .022) than the control group. The NAA correlated positive and significantly with triiodothyronin (Rho = .64) and the estimate level of intelligence measured with the vocabulary subtest of the WISC-R (Rho=.64). There were also positive correlations with body mass index (Rho = .47) and with attention measured with the coding subtest of the WISC-R (Rho=.51) and negative with loss of weight (Rho = -.51) but they were not statistically significant. At follow-up, there was an increase in body mass index (p=.002), triiodothyronin (p = .005), and insulin-like growth factor 1 (p = .017) and a decrease in cortisol (p = .005). In the MRS a significant increase (p = .013) in NAA was observed. The conclusion would be that NAA, Glx and mI are low in the frontal gray matter of adolescents with anorexia nervosa and specially NAA correlates with some nutritional and cognitive parameters. These alterations seem to be reversible in young patients.     

长沙地区女性促卵泡刺激素水平与骨密度和骨质疏松患病率的关系

目的：调查中国女性年龄相关的血清促卵泡刺激素浓度及其与骨密度和骨质疏松症患病率之间的关系。 方法：于2007-06/2008-06选择自长沙和附近地区20~82岁699名健康的中国女性,排除患有影响骨代谢疾病、服用影响骨代谢药物的个体。其中绝经前妇女464名和绝经后妇女235名,绝经年龄为41~59岁。受试者均知情同意并签定了书面协议书。抽空腹静脉血测定血清卵泡刺激素和黄体生成素浓度。用DXA仪测定腰椎、总髋部、前臂超远端骨密度,评价血清促卵泡刺激素与年龄、骨密度和患骨质疏松症风险的关系。 结果：促卵泡刺激素约从40岁起随增龄而增加,到60岁又随增龄而下降。促卵泡刺激素与不同部位骨骼的骨密度呈显著负相关。在腰椎、总髋部、前臂超远端,促卵泡刺激素四分位数的骨质疏松症平均患病率分别为0.57%,0.43%,27.1%,30.9%。与一分位数和三分位数比较,四分位数的妇女骨质疏松症患病率和患病风险显著增加;与三分位数比较,处于四分位数的妇女骨质疏松症患病率和患病风险也显著增加,特别是在腰椎。 结论：血清促卵泡刺激素水平与骨密度的变化呈负相关,和骨质疏松症的发生呈正相关。     

Bone mineral density in survivors of childhood brain tumours

Background Osteopenia has been reported in children surviving acute lymphoblastic leukaemia, apparently as consequence of therapy. Few studies have been published on bone mineral density (BMD) evaluation in children surviving from brain tumours. The endocrine system in these patients is frequently affected as consequence of therapeutic interventions such as cranial irradiation and anti-neoplastic agents: growth hormone deficiency is the most common adverse sequel. The pathogenesis of osteopenia in brain cancer survivors is multi-factorial but still uncertain.Objective The aim of this study is to examine bone mass in 12 brain cancer survivors and its relationship with their hormonal status.Results and discussion We observed that most of the patients had a BMD that was lower than normal in both the lumbar column and in the femoral neck. Bone mass loss was higher in the lumbar region rather than in the femoral neck, due to spinal radiation therapy and to the effect of hormonal deficiencies. Particularly hypogonadism, but also multiple hormonal deficiencies, are associated with lower BMD values. Experience in clinical care of these patients suggests the importance of periodic evaluations of BMD, especially in those with secondary hormone deficiencies. Moreover, the periodic assessment of the hypothalamus–pituitary function is essential for an early diagnosis of hormonal insufficiency, primarily hypogonadism, to precociously detect bone mineral loss and to prevent pathological fractures, thus improving the quality of life.     

抑郁症病人与正常人骨矿物质密度的对照研究

目的 研究抑郁症病人是否存在骨矿物密度的异常并探讨其机理。方法 用单光子骨矿物质密度测定仪测查３４例抑郁症病人尺,桡骨下１／３处骨矿物质密度并与正常人进行对照,要抑郁症病人尺,桡骨骨矿物质密度均较同性别的正常对照显著下降。结论 抑郁症是骨质疏松症是一个重要危险因素,可能与抑郁症病人伴有的神经内分泌及免疫功能改变有关。     

Perceptions of family relationships in adolescents with anorexia nervosa and their unaffected sisters

The family relationships of patients with anorexia nervosa (AN) have been extensively studied over recent years. However, using case-control designs with unrelated controls is subject to various cultural and familial biases. Studying subjective differential perceptions of family relationships in sister-pairs discordant for the disorder may overcome some of these limitations. The aim of the present study was therefore, to investigate subjective perceptions of family environments in a clinically ill sample of female adolescent patients with acute AN and in their healthy sisters using the Subjective Family Image Test. We found significantly lower perceived individual autonomy and higher perceived cohesion in patients compared with their sisters but no difference in perceived emotional connectedness. Lower perceived individual autonomy of the ill children resulted mainly from their relationships with mothers but also in part from their relationships with fathers. This observed pattern might contribute to the maintenance of the disorder and should be addressed in individual and family interventions. Accepted: 15 April 2002 Correspondence to A. Karwautz, MD, Prof.     

Medical Findings in Women with Anorexia Nervosa in a Korean Population

Objective

Eating disorders are a common clinical problem among young women in Asian countries. The aim of this study is to determine the medical effects of anorexia nervosa (AN) in the Korean population.

Methods

We comprehensively investigated medical complications including haemodynamic, haematologic, endocrine, and bone density abnormalities in 67 Korean women with AN, together with 194 healthy Korean women of comparable age with a cross-sectional design.

Results

In AN, 36.9% were anaemic, 50.8% were leukopenic, 35.5% were hypoproteinemic, 7.9% were hypokalemic, 9.5% had increased alanine aminotransferase, 6.3% were hyperbilirubinemia, 14.5% were hypercholesterolemia, 14.8% had decreased triiodothyronine. Osteopenia at any one site was identified in 43.3% and an additional 13.4% had osteoporosis. The lowest-ever body mass index was the main determinant of bone mineral density.

Conclusion

Our data in Korean patients with AN show high frequencies of laboratory abnormalities for medical complications. This study emphasizes the importance of recognizing AN as a medical risk in young Korean women.     

Cerebellar abnormalities in mental illness. A study on Purkinje cell density in schizophrenic men

The linear Purkinje cell density in the cerebellar vermis was investigated in a small cohort of adult onset schizophrenic men with well-documented hippocampal abnormalities. There were no differences in comparison with age-matched controls. This negative finding indicates that vermian abnormalities undoubtedly seen in some schizophrenic patients may constitute a subsyndrome, possibly related to autistic disorders in which cerebellar abnormalities are well corroborated. Accepted: 28 April 1999     

Bone mineral density accrual in students with autism spectrum disorders: Effects of calcium intake and physical training

The purpose of this study was to investigate the effects of weight bearing exercise and calcium intake on bone mineral density (BMD) of students with autism spectrum disorders. For this reason 60 boy students with autism disorder (age 8-10 years old) were assigned to four groups with no differences in age, BMD, calcium intake, and physical activity: exercise groups with or without calcium supplementation (Ex+Ca+ and Ex+Ca−) and non-exercise groups with or without calcium supplementation (Ex−Ca+ and Ex−Ca−). The intervention involved 50 min of weight bearing exercise performed 3 sessions a week and/or the addition of dietary calcium rich food using enriched cow milk with vitamin D containing 250 mg calcium per serving, over 6 months. Paired-samples t test, one way ANOVA analysis, and Tukey tests were used to determine the main and combined effects of training and calcium on BMD. All groups showed greater femoral neck BMD after 6 months. The increase in femoral neck BMD in the Ex+Ca+ group was 14.04% greater than increase in the Ex+Ca− group (P < 0.05). Apparently, the effect of training was greater than calcium intake because the Ex+Ca− group achieved 4.71% greater BMD than Ex−Ca+ group (P < 0.05). In this study, all experimental groups had greater BMD than the control group (Ex−Ca−) (P < 0.05).In these participants, additional weight bearing exercise and calcium supplementation resulted in a greater increase in BMD than controls at the loaded site (femoral neck). These results help to provide more evidence for public health organizations to deal with both exercise and nutrition issues in children with autism disorder for the achievement and of peak BMD.