Assessment and clinical management of bone disease in adults with eating disorders: a review

Abstract

AimTo review current medical literature regarding the causes and clinical management options for low bone mineral density (BMD) in adult patients with eating disorders.BackgroundLow bone mineral density is a common complication of eating disorders with potentially lifelong debilitating consequences. Definitive, rigorous guidelines for screening, prevention and management are lacking. This article intends to provide a review of the literature to date and current options for prevention and treatment.MethodsCurrent, peer-reviewed literature was reviewed, interpreted and summarized.ConclusionAny patient with lower than average BMD should weight restore and in premenopausal females, spontaneous menses should resume. Adequate vitamin D and calcium supplementation is important. Weight-bearing exercise should be avoided unless cautiously monitored by a treatment team in the setting of weight restoration. If a patient has a Z-score less than expected for age with a high fracture risk or likelihood of ongoing BMD loss, physiologic transdermal estrogen plus oral progesterone, bisphosphonates (alendronate or risedronate) or teriparatide could be considered. Other agents, such as denosumab and testosterone in men, have not been tested in eating-disordered populations and should only be trialed on an empiric basis if there is a high clinical concern for fractures or worsening bone mineral density. A rigorous peer-based approach to establish guidelines for evaluation and management of low bone mineral density is needed in this neglected subspecialty of eating disorders.

Medical findings in 1,026 consecutive adult inpatient–residential eating disordered patients

“…Therefore, each time a patient enters treatment, they should be asked when their last DXA was performed. There however remains a paucity of randomized controlled trials to inform the treatment of osteopenia in eating disorders (Drabkin, Rothman, Wassenaar, Mascolo, & Mehler, ).…”

“…There however remains a paucity of randomized controlled trials to inform the treatment of osteopenia in eating disorders (Drabkin, Rothman, Wassenaar, Mascolo, & Mehler, 2018).…”

Weight loss practice, nutritional status, bone health, and injury history: A profile of professional jockeys in Korea

“…We confirmed that many jockeys have extreme weight loss routines that mainly involve restricting calories and/or inducing dehydration. A large number of studies have pointed out that this eating disorder pattern, including starvation, exercise-induced dehydration, binge eating, and vomiting has a high association with numerous disorders 8 , 12 , 23 . People with eating disorders are not only more likely to have various health problems such as gastrointestinal disorders, low bone density, and hormonal problems in later life, they are less likely to reach peak athletic performance owing to low available energy 10 , 15 .…”

Factors influencing bone loss in anorexia nervosa: assessment and therapeutic options

“…Testosterone also impacts bone, both directly and through its aromatisation from oestradiol. Low testosterone levels have adverse effects on bone, and an increase in testosterone levels following weight gain is a strong predictor of an increase in BMD in girls with AN 16–18…”