Leptin levels in restricting and purging anorectics

Mehler, Philip S.; Eckel, Robert H.; Donahoo, William T.

doi:10.1002/(sici)1098-108x(199909)26:2<189::aid-eat8>3.0.co;2-v

“…Whereas central leptin is deleterious to the axial skeleton (Ducy, et al 2000; Hamrick, et al 2004), peripheral leptin has bone anabolic effects (with possible osteoclast inhibitory effects as well), particularly on the appendicular skeleton (Hamrick, et al 2005; Hamrick et al 2004). Levels of leptin are low in AN (Mehler, et al 1999; Misra, et al 2005b), likely an adaptive mechanism to increase appetite, and lower leptin levels are associated with lower fat mass and bone density measures (Lawson et al 2010). Adiponectin is another adipokine that is deleterious to bone based on studies in post-menopausal women and adult men (Biver, et al 2011; Jurimae, et al 2008).…”

Section: Factors Contributing To Impaired Bone Metabolism In Anorexiamentioning

confidence: 99%

Anorexia nervosa and bone

Misra¹,

Klibanski²

2014

Journal of Endocrinology

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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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“…Leptin levels are thought to represent the fat stores in the body 54 and are a major trigger hormone for the adaptation to starvation 55 . Leptin levels have been found to be lower in patients with AN compared with controls 56 . Leptin has also been shown to predict fat mass and eating‐disordered behavior in both malnourished patients with AN as well as during the process of recovery 57–59 .…”

Section: Eating Disorders and Menstrual Dysfunctionmentioning

confidence: 99%

Eating Disorders and Menstrual Dysfunction in Adolescents

Vyver

¹

,

Steinegger

²

,

Katzman

³

2008

Annals of the New York Academy of Sciences

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Menstrual dysfunction is a common feature of all eating disorders and results in significant medical complications. The etiology of menstrual dysfunction is multifaceted and the result of a complex interplay of many factors including weight loss, decreased body fat, hypoleptinemia, abnormal eating attitudes and behaviors, exercise, and psychological stressors. This chapter will review the prevalence of menstrual dysfunction in adolescents with eating disorders, its multifactorial etiology, the evidence-based pathophysiology, and the resulting complications to linear growth, pubertal development, bone mineral accretion, and cognitive function. Future research directions are identified that suggest opportunities to gain new insights into our understanding of the mechanisms and treatment of menstrual dysfunction in adolescents with eating disorders.

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“…Whereas central leptin is deleterious to the axial skeleton (Ducy, et al 2000;Hamrick, et al 2004), peripheral leptin has bone anabolic effects (with possible osteoclast inhibitory effects as well), particularly on the appendicular skeleton (Hamrick, et al 2005;Hamrick et al 2004). Levels of leptin are low in AN (Mehler, et al 1999;Misra, et al 2005b), likely an adaptive mechanism to increase appetite, and lower leptin levels are associated with lower fat mass and bone density measures . Adiponectin is another adipokine that is deleterious to bone based on studies in post-menopausal women and adult men (Biver, et al 2011;Jurimae, et al 2008).…”

Section: Changes In Hormonal Axesmentioning

confidence: 99%

Anorexia nervosa and bone

Schorr

¹

,

Klibanski

²

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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Leptin levels in restricting and purging anorectics

Cited by 26 publications

References 13 publications

Anorexia nervosa and bone

Anorexia nervosa and bone

Eating Disorders and Menstrual Dysfunction in Adolescents

Anorexia nervosa and bone

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