Is Serum Serotonin Involved in the Bone Loss of Young Females with Anorexia Nervosa?

Abstract

Recent experimental data suggest that circulating serotonin interacts with bone metabolism, although this is less clear in humans. This study investigated whether serum serotonin interferes with bone metabolism in young women with anorexia nervosa (AN), a clinical model of energy deprivation. Serum serotonin, markers of bone turnover [osteocalcin (OC), procollagen type I N-terminal propeptide (PINP), type I-C telopeptide breakdown products (CTX)], leptin, soluble leptin receptor (sOB-R), and insulin-like growth factor-1 (IGF-1) and its binding protein (IGFBP-3) were assessed. Whole body, spine, hip, and radius areal bone mineral density BMD (aBMD) were assessed by dual-energy X-ray absorptiometry in 21 patients with AN and 19 age-matched controls. Serum serotonin, leptin, IGF-1, IGFBP-3, OC, PINP, and aBMD at all sites, radius excepted, were significantly reduced in AN whereas CTX and sOB-R were increased compared with controls. Serum serotonin levels were positively correlated with weight, body mass index, whole body fat mass, leptin, and IGF-1, and negatively with CTX for the entire population. Low serum serotonin levels are observed in patients with AN. Although no direct link between low serum serotonin levels and bone mass was identified in these patients, the negative relationship between serotonin and markers of bone resorption found in all population nevertheless suggests the implication of serotonin in bone metabolism. Impact of low serum serotonin on bone in AN warrants further studies.

Eating disorders and bone metabolism in women

“…However, in a cross-sectional analysis of serum serotonin, BMD and bone metabolism markers, a negative relationship was noted between serum serotonin and bone turnover markers [58*], suggesting that this warrants further study. At least one study has demonstrated that a longer duration of use of selective serotonin reuptake inhibitors is associated with lower BMD in young women with AN even after controlling for the duration since diagnosis and duration of amenorrhea [59].…”

Effects of the two types of anorexia nervosa (binge eating/purging and restrictive) on bone metabolism in female patients

“…It is now well established that women suffering from AN exhibit impaired bone remodelling due to the uncoupling of bone formation and bone resorption, which reduces areal bone mineral density (aBMD) at the appendicular and axial bone sites . The kinetics of bone loss in AN patients is specific and characterized by intense and very early bone loss .…”

“…6 It is now well established that women suffering from AN exhibit impaired bone remodelling due to the uncoupling of bone formation and bone resorption, 7-10 which reduces areal bone mineral density (aBMD) at the appendicular and axial bone sites. [8][9][10][11] The kinetics of bone loss in AN patients is specific and characterized by intense and very early bone loss. 9,12,13 Demineralization may be detected in adolescent girls in as little as 6-12 months after disease onset 12 and osteoporosis can then occur within 24 months.…”

Serotonin and Idiopathic Scoliosis: A Review of Related Etiology and Treatment Considerations

“…Furthermore, alterations in serotonin levels have been observed in patients changes in bone resorption. Maïmoun et al [18] conducted a study that compared serum serotonin levels between individuals with adolescent idiopathic scoliosis (AIS) and healthy controls. The study found lower levels of serum serotonin were related to higher levels of bone resorption markers, suggesting a potential serotonin deficiency in these individuals.…”