Osteoporosis in Pre-menopausal Patients With Anorexia Nervosa: Management, Challenges and Review of Literature

Anorexia nervosa (AN) is a group of psychiatric disorders identified by severe calorie restriction and low body mass index (BMI), which can lead to complications such as osteoporosis. Osteoporosis in AN patients can be particularly challenging to manage as it affects majorly a young and pre-menopausal demographic (most commonly diagnosed when under 25 years of age) and lack of clear pharmacological guidelines within this population. We present the case of a 39-year-old woman with a long-standing history of AN who was diagnosed with osteoporosis through dual energy X-ray absorptiometry (DEXA) scan. Over the subsequent years, pharmacological treatments were trialed; however, many were stopped either due to unwanted side effects or concerns regarding long-term risks in a young woman. Eventually, the consensus was reached to focus on improving her nutrition and weight gain, which remains the best-evidenced method of improving bone mineral density in patients with AN. This case highlights the difficulties in treating osteoporosis in premenopausal patients with AN and indicates the need for more research in this population and clear pharmacological guidelines for healthcare professionals.