Jessica Mumford1, Michael Kohn2, Julie Briody3, Jane Miskovic-Wheatley4, Sloane Madden4, Simon Clarke5, Andrew Biggin6, Aaron Schindeler7, Craig Munns8. 1. Eating Disorder Service, Sydney Children's Hospital Network, Westmead, New South Wales, Australia; School of Rural Medicine, University of New England, Armidale, New South Wales, Australia. 2. Eating Disorder Service, Sydney Children's Hospital Network, Westmead, New South Wales, Australia; Adolescent and Young Adult Medicine, Westmead Hospital, Westmead, New South Wales, Australia. 3. Nuclear Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia. 4. Eating Disorder Service, Sydney Children's Hospital Network, Westmead, New South Wales, Australia. 5. Adolescent and Young Adult Medicine, Westmead Hospital, Westmead, New South Wales, Australia; The Children's Hospital at Westmead, Westmead, New South Wales, Australia. 6. Department of Endocrinology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia. 7. Orthopaedic Research Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics & Child Health, University of Sydney, Sydney, New South Wales, Australia. 8. Department of Endocrinology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics & Child Health, University of Sydney, Sydney, New South Wales, Australia. Electronic address: craig.munns@health.nsw.gov.au.
Abstract
PURPOSE: Anorexia nervosa (AN) is a chronic and life-threatening eating disorder that can have a considerable negative impact on the growing skeleton. We hypothesized that the long-term impact on bone health may persist even after normalization of body weight. METHODS: 41 females (mean age 21.2 ± 2.9 years) with a history of adolescent-onset AN attended a follow-up bone health assessment at 5 years (T5, n = 28) or 10 years (T10, n = 13) after their first AN-related hospital admission. Assessment included dual-energy x-ray absorptiometry measurements of the total body, lumbar spine, and proximal femur, peripheral quantitative computed tomography at the radius and tibia, anthropometric measurements, serum biochemistry, fracture history, and a patient questionnaire. RESULTS: A recovery in body weight and BMI was seen for both the T5 and T10 cohorts (BMI at intake 16.6, BMI at T5-T10 21.2-21.3). Dual-energy x-ray absorptiometry body composition indicated a recovery of fat mass and lean tissue mass. Total BMD was unaffected, but reductions were seen at the femoral neck and arms. Peripheral quantitative computed tomography showed reduced trabecular and cortical bone in the radius, and cortical thinning in the tibia. AN patients showed a statistically significant reduction in measures of radiographic bone health at follow up, although not to a degree that necessitated clinical intervention. Serum insulin-like growth factor 1 was also positively correlated with total BMD and BMC measures. While fracture risk was not increased, a subset of participants (8%) showed multiple (>4) fractures. CONCLUSION: A longitudinal study of adolescent AN showed persisting negative effects on bone health. Crown
PURPOSE:Anorexia nervosa (AN) is a chronic and life-threatening eating disorder that can have a considerable negative impact on the growing skeleton. We hypothesized that the long-term impact on bone health may persist even after normalization of body weight. METHODS: 41 females (mean age 21.2 ± 2.9 years) with a history of adolescent-onset AN attended a follow-up bone health assessment at 5 years (T5, n = 28) or 10 years (T10, n = 13) after their first AN-related hospital admission. Assessment included dual-energy x-ray absorptiometry measurements of the total body, lumbar spine, and proximal femur, peripheral quantitative computed tomography at the radius and tibia, anthropometric measurements, serum biochemistry, fracture history, and a patient questionnaire. RESULTS: A recovery in body weight and BMI was seen for both the T5 and T10 cohorts (BMI at intake 16.6, BMI at T5-T10 21.2-21.3). Dual-energy x-ray absorptiometry body composition indicated a recovery of fat mass and lean tissue mass. Total BMD was unaffected, but reductions were seen at the femoral neck and arms. Peripheral quantitative computed tomography showed reduced trabecular and cortical bone in the radius, and cortical thinning in the tibia. AN patients showed a statistically significant reduction in measures of radiographic bone health at follow up, although not to a degree that necessitated clinical intervention. Serum insulin-like growth factor 1 was also positively correlated with total BMD and BMC measures. While fracture risk was not increased, a subset of participants (8%) showed multiple (>4) fractures. CONCLUSION: A longitudinal study of adolescent AN showed persisting negative effects on bone health. Crown
Keywords:
Anorexia nervosa; Bone; Bone density; Bone mineral density; Bone morphology; DXA; Dual-energy x-ray absorptiometry; Peripheral quantitative computed tomography; pQCT
Authors: Vibha Singhal; Amita Bose; Meghan Slattery; Melanie S Haines; Mark A Goldstein; Nupur Gupta; Kathryn S Brigham; Seda Ebrahimi; Kristin N Javaras; Mary L Bouxsein; Kamryn T Eddy; Karen K Miller; David Schoenfeld; Anne Klibanski; Madhusmita Misra Journal: J Clin Endocrinol Metab Date: 2021-06-16 Impact factor: 5.958