[Eating disorders. Osteoporosis and infertility after anorexia nervosa]

EATING DISORDERS: The development of somatic complications observed in patients with eating disorders depends both on the duration of the clinical course and on the gravity of the symptoms and psychological factors. It would thus appear advisable to obtain a complete endocrine (gonadotropic, thyroid, hypothalamo-hypophyseal-adrenal) work-up which could be repeated every year after the patient has controlled the behavior disorder. Two aspects of these complications predominate: osteoporosis and infertility. OSTEOPOROSIS: A common finding after anorexia nevrosa, osteoporosis can lead to multiple, sometimes spontaneous, fractures. Bone mass can be assessed with biphotonic absorptiometry. The indication for estroprogestogen prophylaxis is debatable, depending on the patient's psychological profile, but also because efficacy has not always been demonstrated. Third-generation biphosphonates appear to offer promising results. INFERTILITY: Among a population of women consulting for infertility, a non-negligible percentage have infraclinical manifestations of anorexia nevrosa. The question of prescribing estroprogestogens, which would allow normal cycles and a certain vaginal trophicity, is often raised. We advocate a dose coordination between endocrinologists, infertility specialists and psychiatrists in order to better define the precise modalities of a given treatment aimed at regulating hypothalamo-pituitary function or favoring procreation.