Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Anoreksiya Nervozalı ve Atipik Anoreksiya Nervozalı Ergenlerin Kemik Sağlığı: Retrospektif Kesitsel Bir Araştırma
Bone Health in Adolescents with Anorexia Nervosa and Atypical Anorexia Nervosa: A Retrospective Cross-sectional Study
Melis PEHLİVANTÜRK KIZILKANa, Elif SABANCIb, Şeyma ERDEM TORUNb, Sinem AKGÜLa, Orhan DERMANa, Nuray KANBURa
aHacettepe Üniversitesi Tıp Fakültesi, Ergen Sağlığı BD, Ankara, Türkiye
bHacettepe Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları ABD, Ankara, Türkiye
Turkiye Klinikleri J Pediatr. 2022;31(2):67-73
doi: 10.5336/pediatr.2021-87213
Article Language: TR
Full Text
ÖZET
 Amaç: Anoreksiya nervozada (AN), özellikle düşük vücut ağırlığı nedeniyle kemik sağlığının bozulduğu bilinmektedir. Atipik AN'de (AAN), vücut ağırlığı normaldir; ancak hızlı ve yüksek miktarda kilo kaybı ve hastalık ilişkili ağır besinsel yetersizlik gibi etmenler kemik sağlığını olumsuz yönde etkileyebilir. Bu çalışmanın amacı, AN ve AAN tanısı olan ergenlerin, kemik mineral dansitesi (KMD) ve kemik sağlığına etki eden klinik özellikler açısından karşılaştırılmasıdır. Gereç ve Yöntemler: Kliniğimizde 2014 ve 2018 yılları arasında izlenen, 11-18 yaş aralığında, çift enerjili X ışını soğurma cihazı ile ölçülmüş KMD verisi olan 60 AN ve 30 AAN hastasının klinik verileri geriye dönük olarak incelenmiştir. Bilinen kronik hastalığı olmayan ve herhangi bir ilaç kullanmayan sağlıklı 20 ergen kontrol grubunu oluşturmuştur. Bulgular: Femur başı (p=0,001) ve lomber vertebra (p=0,004) ortalama z skorları, AN grubunda AAN'ye göre daha düşük saptanırken; AAN ve kontrol grubu arasında fark bulunmamıştır. Öte yandan düşük KMD (z skoru ≤-2, p=0,0018) ve düşük KMD riski (z skoru ≤-1, p=0,0036) olanların oranı, AAN'de kontrol grubuna göre daha yüksektir. Obezite öyküsü, AAN grubunda AN'ye göre daha fazladır. Kilo kaybetme hızı ve kilo kaybı yüzdesi, her iki grupta benzerdir. Sonuç: AAN ve AN kliniklerinin besin yetersizliği ve kilo kaybı şiddeti açısından benzer olduğu gösterilse de beklenenin aksine AAN hastalarının ortalama KMD z skoru, kontrol grubundan daha düşük bulunmamıştır. Öte yandan AAN grubunda düşük KMD riski olanların sayısı, kontrol grubundan daha fazladır. Bu sonuçlar, obezite öyküsü ve normal vücut ağırlığı gibi koruyucu etmenlere rağmen AAN'si olan ergenlerin de kemik sağlığı açısından risk altında olduğunu göstermektedir.

Anahtar Kelimeler: Atipik anoreksiya nervoza; kemik sağlığı; kemik mineral dansitesi; ergenlik dönemi
ABSTRACT
 Objective: It is known that bone health is impaired in anorexia nervosa (AN), especially due to low body weight. Rapid and severe weight loss and long-term nutritional deficiency might adversely affect bone health in atypical AN (AAN), despite the normal weight status. We aimed to compare the bone mineral density (BMD) parameters and clinical factors that may affect bone health in adolescents with AN and AAN. Material and Methods: The clinical data of 60 AN and 30 AAN patients, aged 11-18 years, who were followed up in our clinic between 2014 and 2018 and had a dual-energy X-ray absorptiometry assessment were retrospectively evaluated. The control group included 20 healthy adolescents without any chronic disease and regular drug use. Results: We found that the femoral neck (p=0.001) and lumbar spine (p=0.004) z scores of the AN group were significantly lower than the AAN group. No significant difference was found between the AAN and the control groups. On the other hand, in adolescents with AAN compared to the control group, the ratio of low BMD (z score ≤2, p=0.0018) and low BMD risk (z score ≤1, p=0.0036) were higher. While obesity history was higher in the AAN group compared to AN, the rate and percentage of weight loss were similar between the two groups. Conclusion: Although, we showed that AN and AAN are clinically similar in terms of weight loss severity and nutritional deficiency; BMD z scores of AAN patients were not lower than controls. However, low BMD risk was higher in AAN compared to the control group. These findings suggest that despite protective factors of AAN, such as higher obesity history and absence of amenorrhea, adolescents with AAN are also at risk for bone health.

Keywords: Atypical anorexia nervosa; bone health; bone mineral density; adolescent period
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