Are patterns of bone loss in anorexic and postmenopausal women similar? Preliminary results using high resolution peripheral computed tomography

Abstract

This study intended to compare bone density and architecture in three groups of women: young women with anorexia nervosa (AN), an age-matched control group of young women, and healthy late postmenopausal women. Three-dimensional peripheral quantitative high resolution computed-tomography (HR-pQCT) at the ultradistal radius, a technology providing measures of cortical and trabecular bone density and microarchitecture, was performed in the three cohorts. Thirty-six women with AN aged 18-30years (mean duration of AN: 5.8years), 83 healthy late postmenopausal women aged 70-81 as well as 30 age-matched healthy young women were assessed. The overall cortical and trabecular bone density (D100), the absolute thickness of the cortical bone (CTh), and the absolute number of trabecules per area (TbN) were significantly lower in AN patients compared with healthy young women. The absolute number of trabecules per area (TbN) in AN and postmenopausal women was similar, but significantly lower than in healthy young women. The comparison between AN patients and post-menopausal women is of interest because the latter reach bone peak mass around the middle of the fertile age span whereas the former usually lose bone before reaching optimal bone density and structure. This study shows that bone mineral density and bone compacta thickness in AN are lower than those in controls but still higher than those in postmenopause. Bone compacta density in AN is similar as in controls. However, bone inner structure in AN is degraded to a similar extent as in postmenopause. This last finding is particularly troubling. This study showed that the degree of deterioration patterns of bone microarchitecture in AN is high, and needs to be deeply analyzed. Especially troubling is the highly significantly reduced number of trabecules in both young AN patients and in healthy late postmenopausal women, compared to healthy young controls. Keywords3D-pQCT; microarchitecture of bone; bone loss; anorexia nervosa; osteoporosis; postmenopausal women.

Forearm bone mineralization in recently diagnosed female adolescents with a premenarchal onset of anorexia nervosa

“…It is therefore advisable that a disturbed trabecular bone mineralization should be systematically investigated, since no clinical predictor could be identified. As suggested by others, our data might indicate that estrogen deficiency might play an important role in the impaired bone mineralization in adolescents with AN (estradiol levels were not measured in the present study) . Physiologic estrogen replacement was shown to increase the spine and hip aBMD in female patients with AN, but data on the radius are lacking …”

“…As suggested by others, our data might indicate that estrogen deficiency might play an important role in the impaired bone mineralization in adolescents with AN (estradiol levels were not measured in the present study). 23 Physiologic estrogen replacement was shown to increase the spine and hip aBMD in female patients with AN, but data on the radius are lacking. 24 The present study has several limitations.…”

Pharmacological treatment options for low Bone Mineral Density and secondary osteoporosis in Anorexia Nervosa: A systematic review of the literature

“…Therefore, post-menopausal women may not serve as an appropriate model to predict treatment outcomes in AN [88].…”

Medical complications of anorexia nervosa and their treatments: an update on some critical aspects

“…The most concerning finding was that the bone inner structure in anorexia nervosa was degraded to a similar extent as in menopause [7]. Individuals who develop anorexia nervosa during adolescence are of especially great concern as normal bone accrual typically continues through the mid-20s and is thus interrupted by the disease.…”