JCEM：神经性厌食男孩的髋关节几何参数受损

先前报道伴有神经性厌食（AN）的青春期男孩与对照组相比，有较低的髋关节骨矿密度（BMD）。尽管已有研究对AN女孩的骨结构进行描述，但在男孩缺少这些资料。使用双能X线吸收测定法（DXA）进行髋关节结构分析（HSA）是一种经过认证的评估髋关节几何形态和骨强度的技术，可以避免定量CT相关的辐射。为了探讨AN男孩与对照组相比，是否有髋关节结构/强度（通过HSA评估）受损，来自美国波士顿麻省总医院神经内分泌科Madhusmita Misra博士及其团队进行了一项研究，该研究发现AN男孩的髋关节几何参数受损，且与较低的瘦体重相关。该研究结果在线发表在2013年5月7日的美国《临床内分泌代谢杂志》(The journal of clinical endocrinology & metabolism)上。
该研究是在临床研究中心进行的一项横断面研究。在31例先前入选的12至19岁男孩（15例伴有AN和16例正常体重对照组）中间使用HSA技术对髋关节进行DXA扫描。主要的评价指标是髋关节结构分析。
该研究结果表明，AN男孩与对照组相比，有较低的体重指数标准差评分（BMI–SDS）（p＜0.0001）。较大比例AN男孩的股骨颈BMD Z值＜-1（60% vs 12.5%，p=0.008）。在窄颈和髀枢使用HAS，AN男孩有较低的横断面积（p=0.03,0.02）和皮质骨厚度（p=0.02,0.03）。髀枢的屈曲率在AN男孩较高（p=0.008）。在控制年龄和身高后，AN男孩的股骨干骨膜下宽度、横断面惯性矩（窄颈和髀枢）和断面系数（所有部位）较低。观察到HSA测量值与瘦体重、睾酮和雌二醇的紧密相关。在多元分析中，瘦体重仍然与大多数HSA测量值相关。
该研究发现，AN男孩的髋关节几何参数受损，且与较低的瘦体重相关。

Hip Structural Analysis in Adolescent Boys with Anorexia Nervosa and Controls.
Abstract
Context:We have reported lower hip bone mineral density (BMD) in adolescent boys with anorexia nervosa (AN) compared with controls. Although studies have described bone structure in girls with AN, these data are not available for boys. Hip structural analysis (HSA) using DXA is a validated technique to assess hip geometry and strength, while avoiding radiation associated with quantitative CT.Objective:We hypothesized that boys with AN would have impaired hip structure/strength (assessed by HSA) compared with controls.Design:Cross-sectionalSetting:Clinical Research CenterSubjects and Intervention:We used HSA techniques on hip DXA scans in 31 previously enrolled boys, 15 with AN and 16 normal-weight controls, 12-19 years oldOutcome Measures:Hip structural analysisResults:AN boys had lower BMI-SDS (p<0.0001), testosterone (p=0.0005) and estradiol (p=0.006) than controls. A larger proportion of AN boys had BMD Z-scores < -1 at the femoral neck (60% vs. 12.5%, p=0008). Using HSA, at the narrow neck and trochanteric region, boys with AN had lower cross-sectional area (p=0.03, 0.02) and cortical thickness (p=0.02, 0.03). Buckling ratio at the trochanteric region was higher in AN (p=0.008). After controlling for age and height, subperiosteal width at the femoral shaft, cross-sectional moment of inertia (narrow neck and femoral shaft) and section modulus (all sites) were lower in AN. Strongest associations of HSA measures were observed with lean mass, testosterone and estradiol. On multivariate analysis, lean mass remained associated with most HSA measures.Conclusions:Boys with AN have impaired hip geometric parameters, associated with lower lean mass.