Rib fractures and anorexia nervosa.

A twenty-five year old patient with long standing anorexia nervosa and recent forced vomiting presented with a pulling sensation in her lower anterior thorax. Seven months later, callus formation over the left tenth rib was documented. Chest x-ray revealed healing fractures of the seventh, ninth, and tenth ribs. Since her oral intake of calcium was low, she was started on a regimen of milk and sun bathing. We postulate her rib fractures were the result of forced vomiting in an individual with fragile bones. The osteoporotic state may have been induced by her malnourished low-estrogen state.