Eating disorders and bone metabolism in women

Abstract

Purpose of this Review Eating Disorders are psychiatric disorders associated with high risk for low bone mineral density (BMD) and fractures. Low BMD is likely to be a consequence of undernutrition, changes in body composition, and hormonal alterations. This review summarizes recent findings regarding: novel strategies for assessing bone outcomes in patients with eating disorders, factors contributing to altered bone metabolism, and possible therapeutic strategies. Recent Findings Emerging research in this field suggests that not only anorexia nervosa (AN), but also bulimia nervosa (BN) results in lower BMD compared to controls. To date studies of bone structure, and all randomized controlled trials (RCTs) examining the impact of various therapies on bone outcomes in AN, have focused on adolescent girls and women. We discuss the impact of AN on bone structure, and associations of resting energy expenditure, marrow adipose tissue (including the ratio of saturated to unsaturated fat), and cold activated brown adipose tissue (BAT) with BMD and bone structure. Promising strategies for treatment include physiological estrogen replacement (rather than oral contraceptives), in adolescent girls with AN, and bisphosphonates, as well as teriparatide, in adult women with AN. Summary Recent data on: (i) BMD and bone structure in adolescent girls and women with eating disorders, (ii) factors that contribute to altered bone metabolism, and (iii) RCTs reporting positive effects of physiologic estrogen replacement, bisphosphonates and teriparatide on bone health provide us with a greater understanding of the impact of eating disorders on bone and novel management strategies.

Treatment-Resistant Blunted HPA Activity, but Reversible Cardiovascular Stress Reactivity in Young Women With Eating Disorders

“…Participants with previous TSST exposure and participants who did not refrain from physical exercise or eating one hour before testing were excluded as well. In contrast, smoking (44) and use of oral contraceptives or estrogene-progesterone combination medication to prevent low bone density (45,46) were permitted. All patients were recruited from the Christoph-Dornier Clinic for Psychotherapy in Münster (Germany) and the Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic in Bochum (Germany).…”

MECHANISMS IN ENDOCRINOLOGY: Anorexia nervosa and endocrinology: a clinical update

“…The review does not consider other eating disorders than AN, and it predominantly focuses on severe illness. As several comprehensive reviews on bone metabolism in AN have been published in recent years (14, 15, 16, 17, 18), this aspect is omitted from the present review.…”

Outcome of childhood anorexia nervosa—The results of a five‐ to ten‐year follow‐up study

“…Anorexia nervosa (AN) is one of the most severe psychiatric disorders and is often associated with a poor outcome along with significant morbidity and mortality rates (Smink, van Hoeken, & Hoek, ). In the long term, individuals with persisting AN often experience other psychiatric disorders associated with high rates of unemployment (Wentz, Gillberg, Anckarsäter, Gillberg, & Råstam, ) and suffer from somatic sequelae such as osteoporosis (Robinson, Micali, & Misra, ) and fertility problems (Fichter, Quadflieg, Crosby, & Koch, ). While the outcome of AN is thought to be more favorable if diagnosed in adolescence rather than in adulthood (Steinhausen, ), knowledge of the outcome of childhood‐onset AN is limited.…”