Recovery from Osteopenia in Adolescent Girls with Anorexia Nervosa*
Osteopenia is a frequent complication of anorexia nervosa (AN). To determine whether the deficit in bone mineral changes during the course of this illness, we studied 15 adolescent patients prospectively for 12-16 months using dual photon absorptiometry of the spine and whole body. At follow-up, mean weight, height, and body mass index (BMI) had increased significantly, although 6 girls had further weight loss or minimal gain (less than 1.2 kg). Spontaneous menses occurred in 2 girls, and 3 others were given estrogen replacement. Bone mineral density of the lumbar spine did not change significantly (mean +/- SD, 0.836 +/- 0.137 vs. 0.855 +/- 0.096 g/cm2), while whole body bone mineral density increased (0.710 +/- 0.118 vs. 0.773 +/- 0.105; P less than 0.05). Despite gains in bone mineral, 8 patients had osteopenia of the spine and/or whole body. Changes in weight, height, and BMI were significant predictors of change in bone mineral density. Increased bone mass occurred with weight gain before return of menses; conversely, weight loss was associated with further decreases in bone density. In 1 patient who failed to gain weight, estrogen therapy resulted in increased spinal, but not whole body, bone mineral. We also studied a second group of 9 women who had recovered from AN during adolescence. All 9 had normal whole body bone mineral for age, but 3 had osteopenia of the lumbar spine. We conclude that osteopenia in adolescents with AN reflects bone loss, perhaps combined with decreased bone accretion. Weight rehabilitation results in increased bone mineral before the return of menses. Estrogen may have an independent effect on bone mass. The persistence of osteopenia after recovery indicates that deficits in bone mineral acquired during adolescence may not be completely reversible.
Available from: Susan Sawyer
- "The optimal management of low BMD in adolescents with eating disorders is unresolved. Weight gain and spontaneous resumption of menses is associated with partial recovery but BMD may not normalize   . Weight gain without resumption of menses is not accompanied by significant increases in BMD . "
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ABSTRACT: The medical practitioner has an important role to play in the management of adolescents with eating disorders, usually as part of a multidisciplinary team. This article reviews the role of the medical practitioner in the diagnosis and treatment of eating disorders, updating the reader on the changing epidemiology of eating disorders, revised diagnostic criteria, newer methods of assessing degree of malnutrition, more aggressive approaches to refeeding, and current approaches to managing low bone mass.
Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Available from: Marta Mesias
- "As a result of these differences, males have a larger bone size and greater thickness after puberty than females, but there is little difference in volumetric density (Prentice et al., 2006). Estrogens are an important determinant of bone mineral density in girls during puberty (Boot et al., 1997); this is confirmed by diverse studies in which girls with an early or regular menarche had higher bone mineral density, while a late menarche or amenorrea in ballet ballerinas or in patients with anorexia nervosa were related to a limited density and even to fractures (Bachrach et al., 1991; Young et al., 1994; Hergenroeder, 1995). Estrogen can decrease the rate of bone turnover, and inhibit the osteoclastic resorption of bone by affecting bone cell differentiation and function. "
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ABSTRACT: Adolescence is an important period of nutritional vulnerability due to increased dietary requirements for growth and development and special dietary habits. Calcium needs are elevated as a result of the intensive bone and muscular development and thus adequate calcium intake during growth is extremely important to reach the optimum peak bone mass and to protect against osteoporosis in the adult age, a major public health threat whose incidence is increasing in Western countries. However, most children and adolescents worldwide fail to achieve the recommended calcium intake. The hormonal changes associated with the pubertal period promote greater mineral utilization, which needs to be satisfied with suitable calcium consumption. Diet, therefore, must contribute nutrients in sufficient quality and quantity to allow maximum bone mass development. Consequently, adolescents should be educated and encouraged to consume adjusted and balanced diets that, together with healthy lifestyles, enable optimal calcium utilization.
Available from: PubMed Central
- "Follow-up studies on BMD in anorexic patients with onset in childhood and adolescence are rare [26-29]; post-discharge histories in most cases are short or show great variation [30-33]. In particular, there still is a lack of prospective studies in this patient group. "
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ABSTRACT: There still is a lack of prospective studies on bone mineral development in patients with a history of early onset Anorexia nervosa (AN). Therefore we assessed associations between bone mass accrual and clinical outcomes in a former clinical sample. In addition to an expected influence of regular physical activity and hormone replacement therapy, we explored correlations with nutritionally dependent hormones.
3-9 years (mean 5.2 +/- 1.7) after hospital discharge, we re-investigated 52 female subjects with a history of early onset AN. By means of a standardized approach, we evaluated the general outcome of AN. Moreover, bone mineral content (BMC) and bone mineral density (BMD) as well as lean and fat mass were measured by dual-energy x-ray absorptiometry (DXA). In a substudy, we measured the serum concentrations of leptin and insulin-like growth factor-I (IGF-I).
The general outcome of anorexia nervosa was good in 50% of the subjects (BMI >/= 17.5 kg/m2, resumption of menses). Clinical improvement was correlated with BMC and BMD accrual (chi2 = 5.62/chi2 = 6.65, p = 0.06 / p = 0.036). The duration of amenorrhea had a negative correlation with BMD (r = -.362; p < 0.01), but not with BMC. Regular physical activity tended to show a positive effect on bone recovery, but the effect of hormone replacement therapy was not significant. Using age-related standards, the post-discharge sample for the substudy presented IGF-I levels below the 5th percentile. IGF-I serum concentrations corresponded to the general outcome of AN. By contrast, leptin serum concentrations showed great variability. They correlated with BMC and current body composition parameters.
Our results from the main study indicate a certain adaptability of bone mineral accrual which is dependent on a speedy and ongoing recovery. While leptin levels in the substudy tended to respond immediately to current nutritional status, IGF-I serum concentrations corresponded to the individual's age and general outcome of AN.
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