Anorexia nervosa und Knochen

Zusammenfassung

Die Anorexia nervosa ist eine psychische Erkrankung noch unbekannter Ätiologie, die durch eine reduzierte Nahrungsaufnahme, deutliche Gewichtsabnahme sowie Angst vor Gewichtszunahme charakterisiert ist. Sie verursacht eine Vielzahl endokrinologischer Veränderungen, wobei das Ausmaß dieser Veränderungen mit dem Grad der Unterernährung zusammenhängt. In Anpassung an diesen Hungerzustand kommt es zu einer deutlichen Veränderung einer Vielzahl von Hormonen und Signalpeptiden, wobei endokrinologische Achsen mit Beteiligung von Hypothalamus, Hypophyse, Gonaden bzw Nebenniere ebenso betroffen sind wie IGF-1 und die Adipokine Leptin, Ghrelin und PPY. Eine wesentliche Komorbidität ist die Reduktion der Knochendichte bis zur Entwicklung einer Osteoporose und die mit ihr verbundene Entwicklung eines erhöhten Frakturrisikos. Dabei sind sowohl der trabeculäre wie auch der corticale Knochen betroffen. Die Wiederherstellung des Gewichts und die Wiederaufnahme der Menstruation haben den stärksten Einfluß auf die Knochenmineraldichte. Zu den weiteren Behandlungsmöglichkeiten gehören neben der grundsätzlichen Psychotherapie die transdermale Therapie mit Östrogen bzw. die subcutane Gabe von Teriparatid.

Abstract

Anorexia nervosa is a psychological disorder of still unknown etiology characterized by reduced food intake, marked weight loss and fear of gaining weight. It causes a variety of endocrinological changes, the extent of which is related to the degree of malnutrition. In adaptation to this state of hunger, there is a marked change in a variety of hormones and signal peptides, with endocrinological axes involving the hypothalamus, pituitary, gonads and adrenal glands, as well as IGF-1 and the adipokines leptin, ghrelin and PPY. A major comorbidity is the reduction of bone density to the development of osteoporosis and the associated development of increased fracture risk. Both trabecular and cortical bone are affected. Restoration of weight and resumption of menstruation have the strongest influence on bone mineral density. Other treatment options include, in addition to basic psychotherapy, transdermal therapy with estrogen or subcutaneous administration of teriparatide.

Schlüsselwörter

Anorexia nervosa - Knochen - Osteoporose - Frakturrisiko

Key words

anorexia nervosa - bone - osteoporosis - fracture risk

Publication History

Received: 20 May 2022

Accepted: 29 July 2022

Article published online:
08 September 2022

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