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

Abstract

Background: Reduced bone mineral density (BMD) is one of the most frequent medical complications of anorexia nervosa (AN). The purpose of this paper was to conduct a systematic review of the association between weight gain/restoration and BMD in adolescents with AN. Methods: Literature searches, study selection, method, and quality appraisal were performed independently by two authors, and data were collated using a narrative approach. Results: Of the 1156 articles retrieved, 19 studies met the inclusion criteria, and their analysis revealed four main findings. First, six studies reported that weight gain and restoration are associated with BMD stabilization after one year of follow-up from baseline. Second, seven studies with longer follow-up periods (≈16 months) reported significant improvements in BMD measures. Third, one study showed that normalization of BMD can be achieved after ≈30-month follow-up of normal-weight maintenance. Fourth, another study showed that male adolescents with AN who achieve weight gain but remain underweight may experience further BMD loss, unlike their weight-restored counterparts (BMI ≥ 19 kg/m2), who show a significant increase in BMD and bone mineral accrual rates that double those of healthy male adolescents. The first two findings can be considered robust, as they are supported by strong evidence. The third and fourth findings, however, derive from single studies and therefore require further confirmation. Conclusion: The literature supports weight gain as an effective strategy for promoting BMD increase in adolescents with AN. However, this process is slow, and improvements do not become detectable until ≈16-month follow-up.

Vitamin D levels strongly influence bone mineral density and bone turnover markers during weight gain in female patients with anorexia nervosa

“…Although our short‐term (≈4 months) weight‐restoration program did prove an efficacious means of normalising BMI in the majority of adolescents, we found no corresponding increase in BMD in this group. However, this is in line with our recent systematic review, which emphasises that, although weight restoration is an effective strategy for promoting BMD increase in adolescents with AN, the process is slow and improvements may not be detectable until 16 months of follow up (El Ghoch et al, ). That being said, our latest data do show that significant increases in spinal BMD can be achieved in a subgroup of adolescent patients with post‐treatment vitamin D levels > 30 ng mL −1 .…”

“…Weight restoration is currently indicated as the core strategy for increasing BMD in patients with AN (El Ghoch et al, ; Misra et al, ), despite several pharmacological approaches having been proposed (Gordon et al, ; Grinspoon, Thomas, Miller, Herzog, & Klibanski, ; Miller et al, ; Misra et al, ; Strokosch, Friedman, Wu, & Kamin, ). Indeed, weight restoration resolves the main physical complications related to malnutrition, and can also improve cognitive function, making psychological interventions more useful and effective (Marzola, Nasser, Hashim, Shih, & Kaye, ).…”

Body composition in anorexia nervosa: Meta‐analysis and meta‐regression of cross‐sectional and longitudinal studies

“…A new finding from our meta‐analysis is that lower fat mass in females with AN was correlated with significantly low bone mineral content and density across the whole body. We speculate that the hormonal cross‐talk between fat and bone tissue may be influencing this association (El Ghoch et al, ; Hawkes & Mostoufi‐Moab, ), potentially mediated through greater bone marrow adipose tissue observed in AN (Fazeli & Klibanski, ; Suchacki & Cawthorn, ). Whole‐body bone mineral content remained low in weight‐recovered individuals with AN.…”

Is Body Fat Percentage a Good Predictor of Menstrual Recovery in Females With Anorexia Nervosa After Weight Restoration? A Systematic Review and Exploratory and Selective Meta-Analysis

“…Secondary amenorrhoea is a common medical complication in females with anorexia nervosa (1)(2)(3), mainly due to weight loss (4) and usually associated with infertility (5,6), reduction in bone mineral density and a higher risk of bone fractures (7)(8)(9). Resumption of menses (ROM) during anorexia nervosa treatment is an important outcome and is considered as a reliable biological indicator of healthy status (i.e.…”