Bone Metabolism in Adolescent Boys with Anorexia Nervosa

Misra, Madhusmita; Katzman, Debra K.; Cord, Jennalee; Manning, Stephanie J; Mendes, Nara; Herzog, David B.; Miller, Karen K.; Klibanski, Anne

doi:10.1210/jc.2008-0170

Cited by 120 publications

(134 citation statements)

References 51 publications

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“…Low BMD is also found in boys with anorexia nervosa and is associated with low testosterone concentrations. 91 Patients with partial eating disorders or those with bulimia nervosa may also have reduced bone mass, especially if they are or have been of low weight. 89,92,93 The "female athlete triad" refers to 3 interrelated conditions seen in female athletes: low energy availability, menstrual dysfunction, and reduced BMD.…”

Section: Secondary Prevention: Assessment Of Populations At Risk For mentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

395

310

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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: Secondary Prevention: Assessment Of Populations At Risk For mentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

395

310

View full text Add to dashboard Cite

show abstract

“…BMI and lean mass are independent predictors of bone density in males and females with AN [55,68,78]. Although lower fat mass is associated with lower bone density, lean mass is a stronger determinant of bone density measures than fat mass, consistent with mechanical loading having a protective effect on bone.…”

Section: Introductionmentioning

confidence: 79%

“…These factors are represented by androgens, which apart from being aromatized to estrogens, have direct effects on osteoblast differentiation and proliferation [53]. In women with AN, a correlation between androgen (testosterone and DHEAS) levels and BMD, as well as in adolescent boys, has been observed [54,55].…”

Section: Introductionmentioning

confidence: 99%

“…Although lower fat mass is associated with lower bone density, lean mass is a stronger determinant of bone density measures than fat mass, consistent with mechanical loading having a protective effect on bone. In adult women with AN, weight gain is associated with a preferential increase in bone density at the total hip, whereas menstrual recovery is associated with an increase in bone density at the spine [55]. In adolescent girls with AN, increases in lean body mass during weight recovery predict increases in bone density [79].…”

Section: Introductionmentioning

confidence: 99%

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The pathophysiological basis of bone tissue alterations associated with eating disorders

Greco

Lenzi

Migliaccio

2016

Hormone Molecular Biology and Clinical Investigation

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Anorexia nervosa (AN) and obesity are two major eating disorders present nowadays in Western countries. They are both characterized by striking body composition variations and hormonal alterations, which impact on skeletal metabolism, inducing bone tissue modifications and, thus, often cause an increased risk for fractures. AN and obesity are characterized by a severe reduction in fat mass and a high expression of it, respectively, and in both conditions hormones secreted or modulated by body fat content are important determinants of low bone density, impaired bone structure and reduced bone strength. In addition, in both AN and obesity, increased marrow adiposity, which correlates with low bone density, has been observed. This review will discuss the pathophysiological basis of bone alterations associated with AN and obesity, conditions of extreme energy deficiency and excess, respectively.

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“…In women and adolescent girls with AN, lower estradiol levels and duration of amenorrhea (Bachrach et al 1990;Baker, et al 2000;Biller et al 1989a;Castro et al 2000;) are key determinants of low bone density. In boys with AN, low testosterone levels predict low spine BMD whereas BMI and lean mass predict total hip and femoral neck BMD (Misra et al 2008a). …”

Section: Changes In Hormonal Axesmentioning

confidence: 99%

Anorexia nervosa and bone

Misra¹

2013

Self Cite

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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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Bone Metabolism in Adolescent Boys with Anorexia Nervosa

Abstract: AN boys have low BMD at multiple sites associated with decreased bone turnover markers at a time when bone mass accrual is critical for attainment of peak bone mass.

Cited by 120 publications

References 51 publications

Optimizing Bone Health in Children and Adolescents

Optimizing Bone Health in Children and Adolescents

The pathophysiological basis of bone tissue alterations associated with eating disorders

Anorexia nervosa and bone

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