A prospective study of changes in bone turnover and bone density associated with regaining weight in women with anorexia nervosa
ABSTRACT Anorexia nervosa (AN) is a condition of self-induced weight loss, associated with an intense fear of gaining weight. Previous studies have shown that bone density may increase with regaining and maintaining normal weight; however, relatively little is known about the changes in bone metabolism that occur during weight restoration. We describe the effect of weight restoration and maintenance of weight over 1 year on bone mineral density (BMD) and bone turnover. We recruited women from the eating disorders services at the South West London and St George's Mental Health NHS Trust, and the Priory and Charter Nightingale Hospitals in London, UK. Details of their AN, fracture history, menstrual history and exercise were obtained by interview and case note review. Morning samples of blood and second void urine were taken for biochemical analysis. BMD was measured by DXA at the lumbar spine (LS), femoral neck (FN), distal radius (RD) and total body bone mineral content (BMC). Patients then entered the treatment program, which includes re-feeding, dietary education and psychotherapy. Over a period of 42 months, we recruited 55 women who agreed to participate in this study and underwent baseline investigations. Of these, 15 (27%) subjects achieved and then maintained their target weight for the duration of the study. At baseline for all subjects (n=55) estradiol levels were lower than the normal reference ranges (both follicular and luteal phases) in 91% of the women. Bone specific alkaline phosphatase (BSAP) concentrations were lower than the premenopausal reference range in 55% of women, and urinary deoxypyridinoline (DPD) was above the premenopausal reference range in 78% of women. Baseline lumbar spine BMD was positively related to BMI (Pearson's r=0.29, P=0.04) and inversely related to bone turnover markers: urinary DPD (Pearson's r=-0.39, P=0.01 and serum BSAP (Pearson's r=-0.3, P=0.06). The 15 patients who regained and maintained weight were followed-up for a mean duration of 69 weeks (SD 7.3, range 54 to 84 weeks). Mean BMI increased from 14.2 (1.7) to 20.2 (0.77) kg/m2 and remained stable throughout follow-up. Menstruation resumed in 8 of the 15 women. Total body BMC and LS BMD increased significantly over the duration of follow-up (by 4.3% each), but FN BMD and distal radius remained stable. Lumbar spine bone area also increased significantly, whereas FN and distal radius did not. These changes were associated with a significant increase in BSAP (P=0.01), and a non-significant trend for a decrease in DPD (P=0.10). Our findings suggest that when women are at low body weight they are in a hypo-estrogenic state, which is associated with imbalance of bone turnover (high bone resorption and low bone formation). This is reversed with weight gain and persists as target weight is maintained and is associated with increases in BMC and BMD.
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ABSTRACT: SummaryHip fractures are the most important type of fracture. Trends in their incidence and a possible relationship with treatments for osteoporosis are subject of debate. Our objective is to analyse changes in the incidence of hip fractures in women in the Basque Country population and the relationship with osteoporosis treatment. ObjectiveHip fractures are the most important type of fracture due to the associated high mortality and morbidity. Our objective is to analyse changes in the incidence of hip fractures in women in the Basque Country population and the relationship with osteoporosis treatment. MethodsAn observational study of hip fracture rates was carried out based on data taken from the Minimum Basic Data Set. Generalised linear models were used to assess the trends in annual rates of hip fractures for each age group. In addition, the total annual use of osteoporosis treatments was analysed. ResultsThe total number of hip fractures increased by 38% from 1994 to 2009. However, the general linear regression models indicated that the changes in the rates were only statistically significant for the 65- to 74- and 75- to 84-year-old age groups. In these groups, there were annual decreases by 2.30% (CI 1.00, 3.59) and 1.32% (CI 0.47; 2.18), respectively. The use of osteoporosis treatments has quadrupled during that time. ConclusionsThe main finding of our study is that from 1994 to 2008, there is a downwards trend in hip fracture rates in the Basque Country for the 65- to 84-year-old age bracket. Given the characteristics of the design of this study, we are not able to infer a relationship between these findings and any specific factor. Nevertheless, the fact that the change has occurred in the age groups which have received the most treatment for osteoporosis may suggest the existence of some kind of association. KeywordsAge-adjusted incidence–Epidemiology–Hip fracture–Trend analyses–Osteoporosis–Osteoporosis treatmentArchives of Osteoporosis 12/2010; 5(1):131-137. DOI:10.1007/s11657-010-0046-4
Article: Anorexia nervosa and osteoporosis.[Show abstract] [Hide abstract]
ABSTRACT: Anorexia nervosa (AN), a condition of severe undernutrition, is associated with low bone mineral density (BMD) in adults and adolescents. Whereas adult women with AN have an uncoupling of bone turnover markers with increased bone resorption and decreased bone formation markers, adolescents with AN have decreased bone turnover overall. Possible contributors to low BMD in AN include hypoestrogenism and hypoandrogenism, undernutrition with decreased lean body mass, and hypercortisolemia. IGF-I, a known bone trophic factor, is reduced despite elevated growth hormone (GH) levels, leading to an acquired GH resistant state. Elevated ghrelin and peptide YY levels may also contribute to impaired bone metabolism. Weight recovery is associated with recovery of BMD but this is often partial, and long-term and sustained weight recovery may be necessary before significant improvements are observed. Anti-resorptive therapies have been studied in AN with conflicting results. Oral estrogen does not increase BMD or prevent bone loss in AN. The combination of bone anabolic and anti-resorptive therapy (rhIGF-I with oral estrogen), however, did result in a significant increase in BMD in a study of adult women with AN. A better understanding of the pathophysiology of low BMD in AN, and development of effective therapeutic strategies is critical. This is particularly so for adolescents, who are in the process of accruing peak bone mass, and in whom a failure to attain peak bone mass may occur in AN in addition to loss of established bone.Reviews in Endocrine and Metabolic Disorders 07/2006; 7(1-2):91-9. DOI:10.1007/s11154-006-9005-1 · 3.81 Impact Factor
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ABSTRACT: Anorexia nervosa and diet-induced amenorrhea have an important impact not only on gynecological health but also on bone mass, especially if the disease is not promptly recognized and treated. This is particularly important because these conditions usually arise in adolescence, when peak bone mass is normally achieved. In this article we discuss the therapeutic issues related to bone loss associated with eating disorders.Annals of the New York Academy of Sciences 01/2007; 1092:91-102. DOI:10.1196/annals.1365.008 · 4.31 Impact Factor