Terapêutica da osteopénia e osteoporose em mulheres com anorexia nervosa

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

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.