Alendronate for the treatment of osteopenia in anorexia nervosa: A randomized double-blind placebo-controlled trial

Golden, Neville H.; Jacobson, Mark Z.; Iglesias, E.A.; Carey, Dennis E.; Meyer, Wendy; Schebenbach, Janet; Hertz, Stanley; Shenker, I. Ronald

doi:10.1016/j.jadohealth.2004.11.021

Cited by 44 publications

(68 citation statements)

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“…123,[125][126][127] Pilot studies have also been conducted in adolescents with anorexia nervosa. 128 In osteogenesis imperfecta, an openlabel study examining the use of cyclic administration of intravenous pamidronate reported reduced pain and fractures associated with dramatic increases in BMD. 119 A recent multicenter, randomized controlled trial found increases in lumbar spine BMD (51% vs 12% in control subjects) with oral alendronate but no significant change in fracture incidence.…”

Section: Bisphosphonatesmentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

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The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost–benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.

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Section: Bisphosphonatesmentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

Self Cite

393

310

View full text Add to dashboard Cite

show abstract

“…In this study, spine and hip BMD increased by 3% and 2% in women with AN following use of risedronate. However, in adolescents with AN, a one-year RCT of alendronate vs. placebo reported no improvement in spine BMD with alendronate (Golden, et al 2005). These differing results in adults vs. adolescents with AN may reflect differences in bone turnover in the two age groups.…”

Section: Other Therapeutic Options For Treating Low Bone Densitymentioning

confidence: 99%

“…These differing results in adults vs. adolescents with AN may reflect differences in bone turnover in the two age groups. Whereas bone resorption is increased in adult women with AN (Golden et al 2005) (which would suggest that anti-resorptive therapies such as bisphosphonates may be effective in improving bone density), bone resorption is decreased in adolescents with AN with an overall reduction in bone turnover Misra, et al 2003b). Thus, further reductions in bone turnover with bisphosphonates may not be as effective in improving bone density in an adolescent population.…”

Section: Other Therapeutic Options For Treating Low Bone Densitymentioning

confidence: 99%

Anorexia nervosa and bone

Schorr

Klibanski

2018

Current Opinion in Endocrine and Metabolic Research

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Anorexia nervosa (AN) is a condition of severe low weight that is associated with low bone mass, impaired bone structure and reduced bone strength, all of which contribute to increased fracture risk., Adolescents with AN have decreased rates of bone accrual compared with normal-weight controls, raising addition concerns of suboptimal peak bone mass and future bone health in this age group. Changes in lean mass and compartmental fat depots, hormonal alterations secondary to nutritional factors contribute to impaired bone metabolism in AN. The best strategy to improve bone density is to regain weight and menstrual function. Oral estrogen-progesterone combinations are not effective in increasing bone density in adults or adolescents with AN, and transdermal testosterone replacement is not effective in increasing bone density in adult women with AN. However, physiologic estrogen replacement as transdermal estradiol with cyclic progesterone does increase bone accrual rates in adolescents with AN to approximate that in normal-weight controls, leading to a maintenance of bone density Z-scores. A recent study has shown that risedronate increases bone density at the spine and hip in adult women with AN. However, bisphosphonates should be used with great caution in women of reproductive age given their long half-life and potential for teratogenicity, and should be considered only in patients with low bone density and clinically significant fractures when non-pharmacological therapies for weight gain are ineffective. Further studies are necessary to determine the best therapeutic strategies for low bone density in AN.

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“…Osteoporosis is not only a problem of females but also of male patients, owing to their deficits in gonadal hormones. 102,103 Treatment of bone mineral density (BMD) • Although calcium and vitamin D supplementation increase BMD in the short term in healthy adolescents, no RCTs have been done in AN 104,105 • Oral oestrogen/progestin has not been found to effectively increase BMD in AN [106][107][108] • One study found that physiological doses of transdermal oestrogen increased spine and hip BMD compared with controls 109 • Although bisphosphonates have been found to increase BMD in adolescents and young adults with AN, the effect is modest and their use is not recommended 110,111 Given the increased fracture risk, dual-energy X-ray absorptiometry scans should be obtained when amenorrhea is present for six months or more 112,113 Cardiovascular system Patients with eating disorders often present with bradycardia, hypotension, arrhythmias and changes in heart rate variability Hypotension and postural changes in heart rate and blood pressure can result from decreased cardiac mass leading to systolic dysfunction, in addition to volume depletion and autonomic dysfunction 117,119,120 Endocrine Girls and boys may present with decelerated linear growth, pubertal delay or pubertal regression, and menstrual dysfunction is common in females. Progesterone level is monotonously low and corresponds to the basal level of first phase of menstrual cycle.…”

Section: Dr Kakhi Is a Child And Adolescent Psychiatric Registrar Andmentioning

confidence: 99%