Anorexia Raises Risk of Long-Term Bone Damage

By Rutledge, Barbara J. | Clinical Psychiatry News, May 2007 | Go to article overview

Anorexia Raises Risk of Long-Term Bone Damage


Rutledge, Barbara J., Clinical Psychiatry News


TAMPA -- Anorexia nervosa reduces bone mass and puts young women at risk for early onset of osteoporosis, just at the time when they should be building peak bone mass, Dr. Steven Crawford said at the annual meeting of the International Society for Clinical Densitometry.

Anorexia nervosa is one of the most common psychiatric diagnoses in adolescent women, with the age of onset showing bimodal peaks at age 14 and 18 years.

Health consequences can be severe. In addition to loss of bone density, patients can suffer cardiovascular problems, muscle loss and weakness, severe dehydration, anemia, and leukopenia. Female patients with anorexia nervosa are amenorrheic. Anorexia nervosa leads to a sevenfold increase in fracture risk. Of adult women with anorexia nervosa, 38% have osteoporosis, and 50% have a bone mineral density (BMD) level below the fracture threshold.

The extent of bone damage is directly affected by the severity of malnutrition and the disease duration. Consequences are more severe when disease onset occurs during the time of peak bone development. Approximately 60% of total bone mass is attained in the growth spurt that normally occurs in adolescence, and skeletal growth essentially is complete by age 18.

"Bone mineral density is lower when anorexia nervosa begins in adolescence than when it occurs in adult life, even when the duration of illness is comparable," said Dr. Crawford, a clinical psychiatrist at the Center for Eating Disorders, Sheppard Pratt Health System, Baltimore.

Pathophysiology of low bone density in anorexia nervosa results from multiple factors, including undernutrition, hypogonadism, altered levels of bone-essential hormones and growth factors, excessive exercise, and hypercortisolism, among others. Undernutrition in anorexia nervosa leads to decreased levels of the sex hormones critical for bone development.

Low BMD occurs at all skeletal sites in patients with anorexia nervosa, affecting both trabecular and cortical bone. …

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