Treatment of anorexia nervosa is associated with increases in bone
mineral density, and recovery is a biphasic process involving both
nutrition and return of menses1–3
Jennifer Dominguez, Linnea Goodman, Surupa Sen Gupta, Laurel Mayer, Sarah Fischer Etu, B Timothy Walsh,
Jack Wang, Richard Pierson, and Michelle P Warren
Background: Recovery from osteoporosis in anorexia nervosa
(AN) is uncertain.
in bone mineral density (BMD) in women with AN and the mech-
anisms of recovery from osteopenia.
Design: We studied BMD and markers of bone formation and re-
sorption, osteocalcin and N-telopeptide (NTX), in patients with AN
(n ? 28) who were following a behavioral weight-gain protocol.
Results: Anorexic patients experienced significant percentage in-
creases in BMD (4.38 ? 7.48% for spine; 3.77 ? 8.8% for hip; P ?
0.05 for both) from admission until recovery of 90% ideal body
weight, achieved over 2.2 mo. NTX concentrations were higher in
patients with AN at admission than in healthy control subjects
(n ?11; 69.0 ? 31.09 and 48.3 ? 14.38 nmol/mmol creatinine,
respectively; P ? 0.05) and in reference control subjects (n ? 30;
? 0.001). In weight-recovered subjects with AN, osteocalcin in-
NTX remained elevated (from 69.0 ? 31.09 to 66.7 ? 45.5 nmol/
mmol creatinine; NS). A decrease in NTX (from 70.7 ? 40.84 to
45.9 ? 22.72 nmol/mmol creatinine; NS) occurred only in the sub-
group of subjects who regained menses with weight recovery.
resorptive state, which we postulate involves full recovery, may
involve a hormonal mechanism and require a return of menses.
in the cachectic state.
Am J Clin Nutr 2007;86:92–9.
teopenia, amenorrhea, bone markers
Anorexia nervosa, bone mineral density, os-
Amenorrhea is a known risk factor for osteopenia, and it oc-
curs with weight loss in persons with anorexia nervosa (AN).
Women with AN are at high risk of fractures and severe osteo-
or oral contraceptives (OCPs) in increasing the bone mass of
women with AN have not consistently shown positive results
(1–5). The mechanism by which the osteopenia develops and
been well defined. The role of nutrition in the recovery of bone
has been underestimated. Indeed, therapy consisting of OCPs or
bone loss (6, 7).
Some studies of indexes of bone turnover in women with AN
a decrease in osteoblastic function (bone formation) and an in-
have been inconsistent (6–12). The mechanisms by which bone
homeostasis is disrupted and recovered in women with AN are
poorly understood. Osteocalcin and N-telopeptide (NTX) are
established biochemical markers of bone formation and resorp-
tion, respectively, and may be used as reliable measures of bone
In this longitudinal study, we studied women with AN before
and after their weight was normalized. We then compared them
with healthy female control subjects and a previously studied
reference population to better understand the changes in bone
mineral density (BMD) and the mechanism of recovery (14; L
Audi, personal communication, 23 November 2004).
SUBJECTS AND METHODS
We studied 28 patients with AN and 11 control subjects. In
addition, we compared our data with those from 30 reference
control subjects (14; L Audi, personal communication, 23 No-
vember 2004). Patients were women with AN who were hospi-
talized for treatment at the Eating Disorder Research Unit at the
MPW), Psychiatry (BTW), and Medicine (MPW and RP), Columbia Uni-
versity Medical Center, New York, NY; New York State Psychiatric Insti-
tute, New York, NY (BTW, LM, and SFE); and St Luke’s–Roosevelt Hos-
pital Center, New York, NY (RP and JW).
2Supported by NIH, National Institute on Child Health and Human De-
velopment grants R01 HD36444-01-5 and K23 DK-02749.
Physicians and Surgeons, Department of Obstetrics and Gynecology, 622
West 168th Street, PH 16-128, New York, NY 10032. E-mail: mpw1@
Received August 4, 2006.
Accepted for publication March 9, 2007.
Am J Clin Nutr 2007;86:92–9. Printed in USA. © 2007 American Society for Nutrition
at China Agricultural University on May 31, 2013
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RECOVERY OF BMD IN ANOREXIA NERVOSA
at China Agricultural University on May 31, 2013