Fracture risk and areal bone mineral density in adolescent females with anorexia nervosa

Abstract

Objective To (i) compare fracture prevalence in adolescent females with anorexia nervosa (AN) vs. normal-weight controls and (ii) examine whether reductions in areal bone mineral density (aBMD) predict fracture risk in females with AN. Methods 418 females (310 with active AN and 108 normal-weight controls) 12–22 years old were studied cross-sectionally. Lifetime fracture history was recorded by a physician during participant interviews. Body composition and aBMD measurements of the whole body, whole body less head, lumbar spine, and hip were assessed by dual-energy x-ray absorptiometry (DXA), and bone mineral apparent density (BMAD) was calculated for the lumbar spine. Results Participants with AN and normal-weight controls did not differ for chronological age, sexual maturity, or height. The lifetime prevalence of prior fracture was 59.8% higher in those with AN compared to controls (31.0 % versus 19.4 %, p = 0.02), and the fracture incidence rate peaked in our cohort after the diagnosis of AN. Lower aBMD and lumbar BMAD were not associated with a higher prevalence of fracture in the AN or control group on univariate or multivariate analyses. Compared to controls, fracture prevalence was significantly higher in the subgroup of girls with AN who had normal aBMD or only modest reductions of aBMD (Z-scores > −1 or −1.5). Discussion This is the first study to show that the risk of fracture during childhood and adolescence is significantly higher in patients with AN than in normal-weight controls. Fracture prevalence is increased in this cohort of subjects with AN even without significant reductions in aBMD.

Medical outcomes for adults hospitalized with severe anorexia nervosa: An analysis by age group

“…The literature on bone density in anorexia nervosa continues to demonstrate clearly that bone density loss is a serious problem in AN that may start earlier than previously understood and in a wider variety of clinical contexts, with meaningful implications for sports engagement, development, and fracture risk. [21][22][23] In conclusion, older patients with severe AN report a sense of shame and anger at perceived abandonment from the healthcare system. 24 The previously reported less favorable outcomes in the older population have been attributed to their disease chronicity as well as the natural biology of ageing.…”

Anorexia Nervosa: Analysis of Trabecular Texture with CT

“…A norexia nervosa is a prevalent eating disorder associated with low bone mineral density (BMD) and impaired bone microarchitecture and bone strength, resulting in increased fracture risk (1)(2)(3)(4). Skeletal sites containing predominantly trabecular bone, such as the lumbar spine, are the most severely affected, and patients with anorexia nervosa have an increased risk for spinal compression fractures (5,6).…”

“…Anorexia nervosa is a common eating disorder that usually affects adolescents and young women, and patients with anorexia nervosa demonstrate multiple hormonal abnormalities that may alter bone turnover, leading to impaired bone accrual, bone loss, and fractures (2,3,(25)(26)(27). Increasing efforts have been made to develop imaging biomarkers on the basis of DXA or CT to assess skeletal integrity and predict fracture risk in anorexia nervosa.…”

Impact of Dietary Intake on Bone Turnover in Patients with Phenylalanine Hydroxylase Deficiency

“…We defined low BMD by ISCD criteria (Z-score <À2) instead of alternative definitions used in previous studies (Demirdas et al 2015). Prevalence of previous fractures, though cause was not assessed, was higher compared to population estimates for adolescent females (44% vs an estimated 19.4-33.9%) (Chevalley et al 2012;Faje et al 2014) and adult females (47.4% vs 25.3%) (Young et al 2011), and much higher than the 20% fracture rate reported in a systematic review of males and females with PAH deficiency (Hansen and Ney 2014). Though BMD was normal in all subjects, uncoupled bone turnover, particularly in younger patients, and high prevalence of vitamin D insufficiency, still suggests potential abnormalities in bone health and vitamin D status in females with PAH deficiency.…”