Reduced bone density and major hormones regulating calcium metabolism in anorexia nervosa

Abstract

Bone density of lumbar vertebrae (L2 to L4) and the whole body in 29 patients with anorexia nervosa were measured by dual photon absorptiometry, and the results were compared with those of 10 age-matched normal controls. The patients had significantly lower bone mineral density (BMD) in L3 and L2-4 than controls. However, there was no difference in whole-body BMD. L3 and L2-4 BMD was positively correlated with body weight and was negatively correlated with duration of illness and amenorrhea. Patients who had been more active 6 months before the time of the study had significantly higher L3 BMD than the less active patients. Most patients had an abnormally low serum estrogen level, whereas the mean serum levels of thyroid hormone (T3, T4), cortisol, calcitonin, parathyroid hormone and vitamin D were within the normal range. No correlation was found between L3 or L2-4 BMD and the levels of these hormones. These results suggest that severe weight loss, low physical activity, longer duration of amenorrhea and deficiency of estrogen contribute to bone loss in patients with anorexia nervosa, whereas calcium-regulating hormones such as parathyroid hormone, calcitonin and vitamin D are unlikely to be a primary contributor to bone loss.

Low prevalence of vitamin D deficiency among adolescents with anorexia nervosa

“…Soyka et al examined mechanisms of bone loss in adolescents with AN and found similar serum 25OHD concentrations among 19 adolescent girls with AN and 19 controls [4]. Kiriike et al found that among 29 patients with AN, most had normal vitamin D concentrations (defined as 25OHD >16 ng/mL) [9]. Another study of 12 patients with AN found no significant difference in the serum 25OHD level between patients and controls [10].…”

The importance of body weight history in the occurrence and recovery of osteoporosis in patients with anorexia nervosa: evaluation by dual X-ray absorptiometry and bone metabolic markers

“…A decrease in bone mineral density (BMD) is frequently seen in patients with anorexia nervosa (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12), and these patients have a higher incidence of fractures compared with healthy young women (13)(14)(15). Although both prospective and follow-up studies have been performed to investigate the risk factors for osteoporosis in anorexia nervosa, in which metacarpal index, single-and dual-photon absorptiometries or quantitative computed tomography have been used to measure BMD (1,2,5,9,11,12,(16)(17)(18)(19)(20), the conclusions regarding the risk factors for osteoporosis remain controversial (5)(6)(7)(8)(9)(10)(11)(12).…”

“…Although both prospective and follow-up studies have been performed to investigate the risk factors for osteoporosis in anorexia nervosa, in which metacarpal index, single-and dual-photon absorptiometries or quantitative computed tomography have been used to measure BMD (1,2,5,9,11,12,(16)(17)(18)(19)(20), the conclusions regarding the risk factors for osteoporosis remain controversial (5)(6)(7)(8)(9)(10)(11)(12). Several longitudinal studies have revealed different recovery patterns of low BMD in the clinical course of anorexia nervosa patients complicated with osteoporosis (16)(17)(18)(19)(20)(21).…”

The effects of bone therapy on tibial bone loss in young women with anorexia nervosa

“…Several studies have reported that binge eating and purging behavior could reduce BMD (Baker, Roberts, & Towell, 2000). However, others found no relation between binge eating/purging behavior and BMD (Iketani et al, 1995;Kiriike et al, 1992). In consideration of these factors, we decided to rule out AN-BP patients in our study.…”

“…Patients with AN have severe emaciation due to decreased food intake secondary to abnormal eating behavior and the pursuit of thinness. AN patients often suffer from physical complications, such as osteopenia and osteoporosis, and often incur pathologic fractures of the hip and/or spine (Brotman & Stern, 1885;Kaplan, Pertschuk, Fallo, & Haddad, 1986;Kiriike et al, 1992;Maugars et al, 1996;Mehler, 2003;Rigotti, Nussbaum, Herzog, & Neer, 1984). The cause of decreased bone mineral density (BMD) in patients with AN is controversial.…”