Bone mineral density in adolescent females with recently diagnosed anorexia nervosa

Wong, Joseph M.; Lewindon, Peter; Mortimer, Robin H.; Shepherd, Ross W.

doi:10.1002/1098-108x(200101)29:1<11::aid-eat2>3.0.co;2-b

Cited by 31 publications

(17 citation statements)

References 27 publications

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“…In a study on 24 adolescent patients with AN, Wong et al found significant correlations between lean mass and BMC/BMD, but no reduced bone mass [65], whereas our results clearly indicate that BMC decisively developed a deficiency in relation to LBM. (This observation is independent of z-scores or t-scores based on any suitable reference population.…”

Section: Discussioncontrasting

confidence: 60%

Bone mineral density in partially recovered early onset anorexic patients - a follow-up investigation

Schulze

Schuler

Schlamp

et al. 2010

Child Adolesc Psychiatry Ment Health

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Background and aimsThere still is a lack of prospective studies on bone mineral development in patients with a history of early onset Anorexia nervosa (AN). Therefore we assessed associations between bone mass accrual and clinical outcomes in a former clinical sample. In addition to an expected influence of regular physical activity and hormone replacement therapy, we explored correlations with nutritionally dependent hormones.Methods3-9 years (mean 5.2 ± 1.7) after hospital discharge, we re-investigated 52 female subjects with a history of early onset AN. By means of a standardized approach, we evaluated the general outcome of AN. Moreover, bone mineral content (BMC) and bone mineral density (BMD) as well as lean and fat mass were measured by dual-energy x-ray absorptiometry (DXA). In a substudy, we measured the serum concentrations of leptin and insulin-like growth factor-I (IGF-I).ResultsThe general outcome of anorexia nervosa was good in 50% of the subjects (BMI ≥ 17.5 kg/m2, resumption of menses). Clinical improvement was correlated with BMC and BMD accrual (χ2 = 5.62/χ2 = 6.65, p = 0.06 / p = 0.036). The duration of amenorrhea had a negative correlation with BMD (r = -.362; p < 0.01), but not with BMC. Regular physical activity tended to show a positive effect on bone recovery, but the effect of hormone replacement therapy was not significant. Using age-related standards, the post-discharge sample for the substudy presented IGF-I levels below the 5th percentile. IGF-I serum concentrations corresponded to the general outcome of AN. By contrast, leptin serum concentrations showed great variability. They correlated with BMC and current body composition parameters.ConclusionsOur results from the main study indicate a certain adaptability of bone mineral accrual which is dependent on a speedy and ongoing recovery. While leptin levels in the substudy tended to respond immediately to current nutritional status, IGF-I serum concentrations corresponded to the individual's age and general outcome of AN.

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Section: Discussioncontrasting

confidence: 60%

Bone mineral density in partially recovered early onset anorexic patients - a follow-up investigation

Schulze

Schuler

Schlamp

et al. 2010

Child Adolesc Psychiatry Ment Health

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“…This is in contrast to a study in which no clinically significant bone loss within the first 12 months of AN was reported 12 . There was a progressive loss of bone mass, with this being more intense in the hip.…”

Section: Discussioncontrasting

confidence: 99%

Regional Skeletal Bone Deficit in Female Adolescents with Anorexia Nervosa: Influence of the Degree of Malnutrition and Weight Recovery in a Two Year Longitudinal Study

Alvaro¹,

Muñoz-Calvo²,

Martínez³

et al. 2007

Journal of Pediatric Endocrinology and Metabolism

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“…A longer duration of illness predicts lower areal BMD, and also impaired bone microarchitecture and volumetric BMD at the distal radius . In addition, in girls with AN, an increase in body weight following treatment of AN is associated with an increase in lean body mass, which is turn predicts an increase in bone density measures …”

Section: Determinants Of Impaired Bone Health In Anorexia Nervosamentioning

confidence: 99%

State of the art systematic review of bone disease in anorexia nervosa

Misra

Golden

Katzman

2015

Intl J Eating Disorders

104

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Objective Low bone mineral density (BMD) is a known consequence of anorexia nervosa (AN) and is particularly concerning during adolescence, a critical time for bone accrual. A comprehensive synthesis of available data regarding impaired bone health, its determinants, and associated management strategies in AN is currently lacking. This systematic review aims to synthesize information from key physiologic and prospective studies and trials, and provide a thorough understanding of impaired bone health in AN and its management. Method Search terms included “anorexia nervosa” AND “bone density” for the period 1995–2015, limited to articles in English. Papers were screened manually based on journal impact factor, sample size, age of participants, and inclusion of a control group. When necessary, we included seminal papers published before 1995. Results AN leads to low BMD, impaired bone quality and increased fracture risk. Important determinants are low lean mass, hypogonadism, IGF-1 deficiency, and alterations in other hormones that impact bone health. Weight gain and menses restoration are critical for improving bone outcomes in AN. Physiologic estrogen replacement as the transdermal patch was shown to increase bone accrual in one study in adolescent females with AN; however, residual deficits persist. Bisphosphonates are potentially useful in adults with AN. Discussion To date, evidence suggests that the safest and most effective strategy to improve bone health in AN is normalization of weight with restoration of menses. Pharmacotherapies that show promise include physiologic estradiol replacement (as the transdermal estradiol patch), and in adults, bisphosphonates. Further studies are necessary to determine the best strategies to normalize BMD in AN.

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Bone mineral density in adolescent females with recently diagnosed anorexia nervosa

Cited by 31 publications

References 27 publications

Bone mineral density in partially recovered early onset anorexic patients - a follow-up investigation

Bone mineral density in partially recovered early onset anorexic patients - a follow-up investigation

Regional Skeletal Bone Deficit in Female Adolescents with Anorexia Nervosa: Influence of the Degree of Malnutrition and Weight Recovery in a Two Year Longitudinal Study

State of the art systematic review of bone disease in anorexia nervosa

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