Near Normalisation of Lumbar Spine Bone Density in Young Women with Osteopenia Recovered from Adolescent Onset Anorexia Nervosa: A Longitudinal Study

Bass, Shona; Saxon, Leanne; Corral, Ann-Marie; Rodda, Christine; Strauss, Boyd Josef Gimnicher; Reidpath, Daniel D.; Clarke, Cathriona

doi:10.1515/jpem.2005.18.9.897

Cited by 37 publications

(23 citation statements)

References 31 publications

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“…(38) Further, in girls recovering from anorexia nervosa, while bone-mass gains were positively associated with weight gain, even those who had established a normal weight did not increase bone mass to normal levels. (39)(40)(41)(42) A previous study by Lucas and colleagues that compared adolescent runners and nonrunners found no differences between runners (n ¼ 15) and nonrunners (n ¼ 27) in body weight or BMD at each bone site, and it therefore was concluded that runners' exercise activity did not negatively affect their bone mass. (43) Although the results of that study might appear contradictory to our findings, the runners in that study sample ranged in age from 12 to 14 years.…”

Section: Discussionmentioning

confidence: 90%

Cross-sectional evidence of suppressed bone mineral accrual among female adolescent runners

Barrack

Rauh

Nichols

2010

Journal of Bone and Mineral Research

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We aimed to evaluate patterns of bone mineral accrual among a cross-sectional sample of female adolescent runners and girls participating in a nonendurance running sport. One-hundred and eighty-three interscholastic competitive female athletes (age 16.0 AE 0.1 years), 93 endurance runners and 90 nonrunners, completed a menstrual and sports history questionnaire, had their height and weight measured, and underwent a dual-energy X-ray absorptiometry scan for the measurements of body composition and bone mass. For the majority of analyses, the girls were separated into four groups according to their age (13 to 14 years, 15 years, 16 years, and 17 to 18 years). Runners' height, weight, body mass index (BMI), percent body fat, lean tissue mass, number of menstrual cycles in the past year, and months of participation in a non-lean-build/variable-impact-loading sport were significantly lower than mean values for nonrunners. Although bone mass rose at all sites in the nonrunners between the ages of 13 to 14 years and 17 to 18 years, no such increase was noted in the runners. Runners compared with nonrunners exhibited significantly lower body weight and height-adjusted total body and lumbar spine bone mineral content (BMC) values and lower bone mineral density (BMD) Z-score values among the older (16 years and/or 17 to 18 years) but not younger (13 to 14 years and/or 15 years) age groups. These findings suggest that the runners, in contrast to the nonrunners, exhibited a suppressed bone mineral accrual pattern, which supports the notion that female adolescent endurance runners may be at risk for inadequate bone mass gains and thus a low peak BMD. ß

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Section: Discussionmentioning

confidence: 90%

Cross-sectional evidence of suppressed bone mineral accrual among female adolescent runners

Barrack

Rauh

Nichols

2010

Journal of Bone and Mineral Research

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“…Duration of observation may be a factor as other studies have reported near normal bone size and volumetric BMD with recovery. 69,102 A recent longitudinal Australian study demonstrated normalisation of volumetric lumbar spine BMD in adolescent-onset disease after 2.7 years of recovery. 102 Bone mass and volume at the third lumbar vertebrae increased by 20 and 14%, respectively.…”

Section: Weight Restoration With Resumption Of Mensesmentioning

confidence: 99%

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

Jayasinghe

Grover

Zacharin

2008

BJOG

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Anorexia nervosa (AN) initiates an adaptive response at the level of the hypothalamus, which results in a complex interplay involving most elements of the neuroendocrine axis. Consequences of onset of disease in adolescence include amenorrhoea, pubertal arrest with potential loss of target height, and osteoporosis with reduced capacity for future attainment of peak bone mass. With recovery, delay in restoration of menses is common. Hormonal therapies for restoration of bone mineral density (BMD) in adolescents have shown limited efficacy. This review will discuss the reproductive endocrine effects of AN in adolescence, and discuss new investigative tools for monitoring restoration of reproductive function and BMD in this population.Keywords Adolescence, amenorrhoea, anorexia nervosa, bone mineral density, eating disorders. IntroductionNinety percent of eating disorders present before the age of 25 years, and in the early stages they may present with menstrual dysfunction. 1 Therefore, it is important that gynaecologists have a good understanding of current concepts of hypothalamic regulation, as those physicians may be the first point of contact in subsyndromal eating disorders. Leptin, a hormone produced by adipocytes, appears to be the critical link between energy homeostasis and neuroendocrine regulation. 2 Since its discovery in 1994, 3 rapid gains in understanding of the hormonal and nutritional regulation of anorexia nervosa (AN) have occurred. 4 These findings are likely to have a significant impact on clinical management of the reproductive-endocrine aspects of AN. Bone loss consequent upon estrogen deficiency may be severe, of long duration with reduced capacity for recovery. Understanding bone loss mechanisms, correct interpretation of bone density measurements and consideration of treatment modalities to ameliorate the problems of eating disorders are an essential part of overall management strategies. EpidemiologyThe Society for Adolescent Medicine together with other medical bodies has recognised that strict Diagnostical and Statistical Manual of Mental Health Disorders-IV (DSM-IV) criteria 5 for AN (particularly requiring weight below 85% of normal and amenorrhoea for 3 months), may not apply to all women. 6,7 This is particularly so in adolescents because of their normal variability in development, and also because adverse health effects occur even in partial syndromes. In adolescence, prevalence of AN is 0.5%, bulimia nervosa is 1% and partial syndromes (eating disorders not otherwise specified) is 2.4-5.0%. 6,[8][9][10] Clinical sequelaeThe clinical sequelae of AN depend on timing of disease in relation to puberty. These may include pubertal delay and primary amenorrhoea, pubertal arrest with potential loss of target height, or secondary amenorrhoea. 11-13 Amenorrhoea has been reported to precede weight loss in 20% of women, which may lead to diagnostic confusion.Low bone mineral density (BMD) is an established risk in AN, with 50% of anorexics demonstrating osteopenia within 20 months of ameno...

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“…The discipline of endocrinology has led the field, through the understanding of the hormonal events of puberty and the studies of the initiation of puberty 11 and longitudinal bone acquisition studies. 12 The absence of easy access to relevant animal models of puberty for research is important, with primates being an obvious but costly choice. In addition, no animal model can reproduce many aspects of human adolescence, including the increasing divide between the timing of puberty and the duration of adolescence.…”

Section: Introductionmentioning

confidence: 99%

Clinical research in adolescents: challenges and opportunities using obesity as a model

et al. 2008

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Adolescent medicine is relatively young, compared to paediatric or adult medicine. Descriptive and observational studies have dominated the adolescent literature, including those studies published in the International Journal of Obesity. In addition, many studies have combined child and adolescent age groups, making it difficult to determine adolescent-specific outcomes. It is important that high quality intervention studies in adolescents occur. Adolescence is a time of extraordinary plasticity. Habits, attitudes and physical morbidity that develop during adolescence set up trajectories that have a profound influence on health and wellbeing for the long term. Overweight and obesity are an excellent example of the need for high quality intervention studies and yet in the last two decades there have been very few randomized, controlled trials of overweight and obesity management in adolescents. There are a number of complexities in adolescent research that create additional challenges to those that accompany any clinical research. These include recruitment and retention, issues around consent and confidentiality and the central role that parents play in supporting the research protocol. Pubertal stage is a potential confounder and needs to be accurately measured. This is certainly true for studies in overweight and obesity where excess adiposity influences pubertal and other hormones. The opportunities to undertake quality research in adolescents are likely to be enhanced by the use of novel approaches which acknowledge the unique features of adolescents and their world.

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Near Normalisation of Lumbar Spine Bone Density in Young Women with Osteopenia Recovered from Adolescent Onset Anorexia Nervosa: A Longitudinal Study

Cited by 37 publications

References 31 publications

Cross-sectional evidence of suppressed bone mineral accrual among female adolescent runners

Cross-sectional evidence of suppressed bone mineral accrual among female adolescent runners

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

Clinical research in adolescents: challenges and opportunities using obesity as a model

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