Bone health in eating disorders

Area of Science:

• Endocrinology
• Bone Biology
• Adolescent Medicine

Background:

• Eating disorders (EDs) pose a significant risk to bone health in adolescents and young adults.
• Low bone mineral density (BMD) in EDs results from impaired peak bone mass accrual and bone loss.
• Bone complications include fractures, stress fractures, kyphoscoliosis, and height loss, with potential for persistent deficits.

Purpose of the Study:

• To elucidate the impact of eating disorders on bone health in adolescents and young adults.
• To identify the mechanisms contributing to bone loss in anorexia nervosa (AN).
• To review the effectiveness of current treatment strategies for improving BMD in ED patients.

Main Methods:

• Review of existing literature on eating disorders and bone health.
• Analysis of factors influencing bone metabolism in anorexia nervosa.
• Examination of clinical presentations and diagnostic criteria for bone impairment in EDs.

Main Results:

• Anorexia nervosa (AN) is associated with low bone turnover, characterized by increased bone resorption over formation.
• Bone loss in AN affects both trabecular and cortical bone, with trabecular bone being more vulnerable.
• Key contributing factors include malnutrition, low weight, reduced fat mass, hormonal deficiencies (estrogen, androgen), excess glucocorticoids, and impaired GH/IGF-1 axis.

Conclusions:

• Bone loss in AN may be irreversible even after clinical recovery.
• Hormonal therapies show limited effectiveness in improving BMD.
• Increased caloric intake, weight gain, and resumption of menstruation are crucial for enhancing BMD in ED patients.