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Terapêutica da osteopénia e osteoporose em mulheres com anorexia nervosa
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Objectivo: rever de forma sistemática a evidência que suporta o tratamento da osteopénia e osteoporose em mulheres com anorexia nervosa. Fontes de dados: identificaram-se estudos clínicos controlados de intervenções em indivíduos com baixa massa óssea através de pesquisas na MEDLINE e Cochrane Library. Os outcomes de interesse foram as alterações na densidade mineral óssea (DMO) medidas por DEXA.
Resultados: sete RCTs, três estudos de coorte e um estudo de caso-controlo abordando os efeitos das várias classes de terapêutica médica da baixa densidade mineral óssea. Três RCT com terapêutica estrogénica revelaram benefícios estatisticamente pouco significativos ao passo que um quarto RCT demonstrou claro benefício; dois RCT e um estudo coorte de bifosfonatos com benefício manifesto por aumento significativo da DMO; dois RCT de DHEA sem benefício demonstrado na DMO no período do estudo, porém com benefícios significativos no aumento de massa magra; um RCT de IGF-I teve benefício como adjuvante da terapêutica estrogénica.
Discussão: Os doentes com anorexia nervosa sofrem decréscimos da massa óssea numa fase da vida em que deveriam optimizar o crescimento ósseo e contribuir para o seu pico de massa óssea. Escasseia evidência de qualidade que possa guiar as intervenções médicas, mas há várias classes terapêuticas que podem vir a desempenhar um papel importante no tratamento destas doentes. Há, porém, que enfatizar a importância do ganho ponderal na prevenção secundária e terciária da osteopénia e osteoporose nos doentes com anorexia nervosa.
Objective: to systematically review the evidence behind the treatment of low bone mass in women with anorexia nervosa. Data sources: Clinical trials regarding interventions for low bone mass in anorectic women were sought via MEDLINE and the Cochrane Library. The outcomes of interest were changes in bone mineral density, as measured by DEXA scans. Results: seven RCTs, three cohort studies and one case control trial were found examining the effects of the several types of drugs conventionally applied in the treatment of low bone mineral density. Three RCTs regarding estrogen therapy showed little benefit, whereas a fourth RCT supported a clear benefit; two RCTs and one cohort study of bisphosphonate therapy showed significant increases in bone mineral density; two RCTs of DHEA failed to show changes in bone mineral density, although there was a significant increase in lean body mass during the intervention; one RCT approaching IGF-1 therapy showed benefit when combined with estrogen therapy. Discussion: Anorexia nervosa patients usually suffer significant losses of bone mass and demineralization during a stage of development when one should expect bone apposition and growth, as to achieve peak bone mass later on. Currently there is little solid evidence to guide medical interventions, but there are a few promising drug classes which may one day become useful in the treatment of these patients. However, one should always be aware of the importance of weight recovery in the secondary and tertiary prevention of osteopenia and osteoporosis in anorexia nervosa patients.
Objective: to systematically review the evidence behind the treatment of low bone mass in women with anorexia nervosa. Data sources: Clinical trials regarding interventions for low bone mass in anorectic women were sought via MEDLINE and the Cochrane Library. The outcomes of interest were changes in bone mineral density, as measured by DEXA scans. Results: seven RCTs, three cohort studies and one case control trial were found examining the effects of the several types of drugs conventionally applied in the treatment of low bone mineral density. Three RCTs regarding estrogen therapy showed little benefit, whereas a fourth RCT supported a clear benefit; two RCTs and one cohort study of bisphosphonate therapy showed significant increases in bone mineral density; two RCTs of DHEA failed to show changes in bone mineral density, although there was a significant increase in lean body mass during the intervention; one RCT approaching IGF-1 therapy showed benefit when combined with estrogen therapy. Discussion: Anorexia nervosa patients usually suffer significant losses of bone mass and demineralization during a stage of development when one should expect bone apposition and growth, as to achieve peak bone mass later on. Currently there is little solid evidence to guide medical interventions, but there are a few promising drug classes which may one day become useful in the treatment of these patients. However, one should always be aware of the importance of weight recovery in the secondary and tertiary prevention of osteopenia and osteoporosis in anorexia nervosa patients.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014
Palavras-chave
Anorexia nervosa Osteoporosis Osteopenia Biphosphonates IGF-1 DHEA