Rib fractures and anorexia nervosa.

Area of Science:

• Internal Medicine
• Gastroenterology
• Orthopedics

Background:

• Anorexia nervosa is a complex eating disorder associated with significant medical complications.
• Patients with anorexia nervosa often have nutritional deficiencies, including low calcium intake.
• Low estrogen levels, common in anorexia nervosa, can lead to decreased bone density.

Observation:

• A 25-year-old female with anorexia nervosa and recent forced vomiting presented with thoracic pain.
• Imaging revealed healing fractures of the seventh, ninth, and tenth ribs.
• Callus formation was noted over the left tenth rib seven months post-presentation.

Findings:

• The patient's rib fractures are postulated to be a consequence of forceful vomiting.
• Fragile bones, potentially due to an osteoporotic state, are implicated in the fracture mechanism.
• The osteoporotic state may be linked to malnutrition and hypogonadism (low estrogen) associated with anorexia nervosa.

Implications:

• This case highlights a potential physical complication of forced vomiting in patients with eating disorders.
• It underscores the importance of assessing bone health in individuals with anorexia nervosa.
• Early diagnosis and management of osteoporosis are crucial for preventing fractures in this vulnerable population.