Ultrasound and X-ray-Based Bone Densitometry in Patients with Anorexia Nervosa

Abstract

In 20 patients (mean age 23+/-5 years) with anorexia nervosa (AN), bone mass was evaluated by broadband ultrasound attenuation (BUA) of the calcaneus, peripheral quantitative computed tomography (pQCT) of the distal radius, and dual X-ray absorptiometry (DXA) of the lumbar spine and the hip. Compared with 20 age- and sex- matched healthy controls, patients with AN showed marked osteopenia at all measuring sites. Values of BUA (33.0+/-9 dB/MHz vs. 51.0+/-5.7 dB/MHz; P<0.0001) and of BMD of all regions of the hip (e.g., femoral neck: 0.71+/-0.13 g/cm(2) versus 0.89+/-0.07 g/cm(2); P<0.001), lumbar spine (0.82+/-0.15 g/cm(2) versus 1.24+/-0.06 g/cm(2); P<0.003) and total BMD of the peripheral radius (303.2+/-75 g/cm(3) versus 369.4+/-53.2 g/cm(3), P<0.001) were significantly reduced. Calculating a Z-score we found the most prominent differences between AN and controls by BUA of the calcaneus (-3.2+/-1.6), followed by DXA at the lumbar spine (-2.9+/-2.2) and the hip (femoral neck -2.1+/-1.7) and by pQCT at the distal radius (total BMD -1.2+/-2.0). There were highly significant correlations between BUA of the calcaneus and BMD of the femoral neck (r = 0.78, P<0.0001) and lumbar spine (r = 0.75, P<0.0001) as well as between BMD values of the femoral neck and lumbar spine (r = 0.95; P<0.0001). In addition, there were significant correlations (P<0.001) between body mass index (BMI) and the three different measuring sites and between the duration of the disease and BUA (r = 0.5, P<0.05). Our data suggest that BUA of the calcaneus is a valuable tool in the management of osteoporosis. Being a fast, radiation-free investigation method of good acceptance, it may be well suited for an assessment of the skeletal status in patients with AN.

Skeletal Measurements by Quantitative Ultrasound in Adolescents and Young Women with Anorexia Nervosa

“…In contrast, broadband ultrasound attenuation (BUA) measurements by QUS in patients with AN were lower than in the healthy subjects. The BUA results at the calcaneus were replicated by Resch et al, 17 who additionally demonstrated significant correlations between BUA and BMD of the femoral neck and lumbar spine. No significant relations were found between BUA and peripheral quantitative computed tomography values of the distal radius.…”

“…In contrast, broadband ultrasound attenuation (BUA) measurements by QUS in patients with AN were lower than in the healthy subjects. The BUA results at the calcaneus were replicated by Resch et al,17 who additionally demonstrated significant correlations between BUA and BMD of the femoral This study used QUS to evaluate the tibia and radius in subjects with AN. As the tibia is a weight-bearing site and a common site for stress fracture in patients with AN who frequently participate in excessive exercise, bone ultrasound measurements at this site would have provided a convenient screening tool for clinicians in the outpatient setting.…”

“…No significant relations were found between BUA and peripheral quantitative computed tomography values of the distal radius. 17 That study did not compare SOS measurements between groups. The Omnisense 7000P QUS used in the current study does not have the capability to measure BUA; thus, this information could not be obtained in the current participants.…”

“…However, to our knowledge, this modality has not been investigated in young women with AN at peripheral sites other than the calcaneus. [15][16][17] The aim of the current study was to compare QUS measurements in patients with AN with that in healthy control subjects and to determine the utility of QUS as a tool to evaluate skeletal status in this patient population. …”

Bone Mass in Anorexia Nervosa and Thin Postmenopausal Women-Related Secondary Amenorrhea

“…A reduced bone mass was also found in young anorexics. (Resch H et al, 2000). Another study demonstrated bone fragility due to small size of bones originated by malnutrition and decreased volumetric BMD caused by hypoestrogenism (Karlsson et al, 2000).…”