ReviewBone loss associated with anorexia nervosa
Section snippets
Bone mineral density
Bone mass can be measured by absorptiometry at the spine and femoral neck. Radiation exposure is minimal with this method. The World Health Organization defines osteoporosis in postmenopausal women as a BMD value at least 2.5 S.Ds. below the mean in young women (T-score < −2.5 S.Ds.), at the spine, femoral neck or radius. This definition may be unsatisfactory in adolescents, who may not have achieved their peak bone mass. Studies comparing BMD values at various sites in patients with anorexia
Hormonal factors
A few studies investigated BMD changes in patients with anorexia nervosa [5], [11], [12], [20], [21]. The BMD values were significantly lower in the patients who were younger than 18 years at disease onset, illustrating the impact of anorexia nervosa on peak bone mass achievement. Amenorrhea is a diagnostic criterion for anorexia nervosa, and estrogen deficiency has been described as a major source of bone loss in this condition. The mechanisms underlying this estrogen deficiency remain
Changes in bone mass after weight regain
The BMD changes during recovery from anorexia nervosa have been investigated [3], [10], [12], [16], [20], [22], [24]. Although bone mass increased when weight returned to normal, several studies showed persistent osteopenia in a large proportion of patients [3], [10], [12], [16], [36]. Hartman et al. [37] studied bone mass at in 19 women with a history of anorexia nervosa followed by a full recovery for a mean of 21 years. Although their body weight was normal, their bone mass at the femoral
Weight regain and menstrual cycle recovery
These two factors improved bone mass in several studies [7], [10], [14], [22], [39] but were not sufficient in another study [12]. Although weight regain and menstrual cycle recovery seem to be prerequisites to bone mass gain, they do not allow a return to normal bone mass values.
Physical activity
Conflicting results have been reported [40]. Although physical activity is needed to achieve peak bone mass and to maintain bone stock in adulthood, its ability to protect against osteoporosis in patients with anorexia
Conclusion
Anorexia nervosa is associated with severe bone loss that must be looked for routinely by obtaining absorptiometry measurements of BMD. The mechanism is multifactorial and incompletely understood. Diminished bone formation may play a greater role than increased bone resorption. The best management is not agreed on. Oral contraceptives have been of little help. Hormone replacement therapy has not been investigated in large studies. Bone formation enhancers such as IGF-I may produce the best
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