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

Abstract

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.

The Association between Weight Gain/Restoration and Bone Mineral Density in Adolescents with Anorexia Nervosa: A Systematic Review

“…Weight gain and/or restoration are associated with a significant increase in BMD after a year, as reported for most of the studies with a follow-up longer than 12 months [40,41,44,45,46,47]. This finding confirms the hypothesis that BMD gain is a slow process in adolescent females with AN, and longer time frames are required to detect improvements.…”

“…In 2010, Schulze et al [46] reported their results of whole-body DXA scans performed in a retrospective non-controlled study of BMD in 52 adolescent females with AN, namely a significant improvement in total BMD after >36-months follow-up from baseline. This was associated with an increase in BMI across the whole sample, from 14.7 ± 1.9 kg/m 2 to 20.1 ± 2.8 kg/m 2 .…”

Avaliação da densidade mineral óssea em adolescentes do sexo feminino com transtorno alimentar

“…A desnutrição causa baixa DMO em mulheres jovens com AN. A rápida perda de massa óssea que ocorre nos primeiros seis meses da doença é bem documentada em mulheres anoréxicas adultas (20,21). No entanto, poucos estudos avaliaram a massa óssea em adolescentes com AN e TANE.…”

Skeletal complications of eating disorders

“…11 Among adult women with AN, those who developed the disease as adolescents have lower bone density measures than those who developed the disease later in life, supporting the critical relationship between adolescent nutritional intake, peak bone mass accrual and life-long bone health. 41 Although skeletal losses that occur during the course of AN can improve with recovery, 42 full recovery cannot always be expected. 1,2,3 …”