Osteoporosis in anorexia nervosa

Abstract

Anorexia nervosa is a condition associated with reduced bone mass and increased bone fragility, for which there is no known effective treatment. Anorexia nervosa usually has its onset during adolescence, the critical time when peak bone mass is accrued. Low bone mass is caused by reduced bone formation, as well as accelerated bone resorption. The etiology is multifactorial and includes poor nutrition, low bodyweight, sex hormone deficiency and hypercortisolism. Weight gain and resumption of menses is accompanied by some improvement in bone mass, but may not restore it to normal levels. Oral estrogen-replacement therapy is not effective in increasing bone mass in this disorder. The bisphosphonates, used in conjunction with nutritional rehabilitation and weight gain, have shown promise, but concerns about safety have limited their use. The aim of this article is to highlight recent recommendations regarding the assessment of fracture risk in children and adolescents, summarize the evidence for low bone mass and increased fracture risk in anorexia nervosa, and discuss approaches to the management of low bone mass in this disorder.

Keywords::

• anorexia nervosa
• bisphosphonates
• bone health
• eating disorders
• osteoporosis

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

Data from the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders, fourth edition [13].