Weight gain reverses bone turnover and restores circadian variation of bone resorption in anorexic patients

Caillot-Augusseau, Anne; Lafage‐Proust, Marie‐Hélène; Margaillan, Philippe; Vergély, N.; Faure, Sylvane; Paillet, Stephane; Lang, François; Alexandre, Christian; Estour, Bruno

doi:10.1046/j.1365-2265.2000.00879.x

Cited by 61 publications

(46 citation statements)

References 35 publications

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“…Some earlier studies have demonstrated reduced osteocalcin and enhanced CTx levels in AN patients (Caillot-Augusseau et al, 2000;Hotta et al, 2000). These previous studies also indicated that the low BMI of AN patients might be a risk factor for disturbed bone turnover.…”

Section: Introductionmentioning

confidence: 81%

“…According to previous results that a quadratic equation can best explain the relation between BMI and bone turnover markers (Caillot-Augusseau et al, 2000), we performed a square root transformation of the data for statistical analysis. The CTx/ osteocalcin ratio was only related to BMI (r ¼ 0.56; Po0.0001) and to FFM (Po0.05) (multiple r ¼ 0.61; Po0.0001).…”

Section: Correlationsmentioning

confidence: 99%

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Body mass index and disease duration are predictors of disturbed bone turnover in anorexia nervosa. A case–control study

et al. 2003

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Objective: To characterize the influence of body mass index (BMI), body composition, hormonal factors and disease duration on bone metabolism markers in anorexia nervosa (AN) patients. Design: Case-control study with 51 AN patients and 51 controls matched for age, sex and body height. Assessment of anthropometric and bioimpedance data, and of biochemical serum parameters and of oral contraceptives use. Results: Patients had a lower BMI, lower fat mass, lower fat-free mass and lower muscle mass (MM) compared to the controls (all P values o0.001). Moreover, serum levels of osteocalcin (bone formation marker) were lower while serum C-telopeptide concentrations (CTx; bone resorption marker) and the CTx/osteocalcin ratio (an index reflecting the balance of bone remodeling) were higher in the AN patients compared to the controls (Po0.01-0.001). In addition, patients had enhanced serum calcium and cortisol levels and reduced serum levels of thyroid hormones, insulin, and leptin (P values o0.05-0.001). Mean disease duration was 91713 months. In a multiple regression analysis, BMI (Po0.0001), MM (Po0.005) and duration of the disease (Po0.005) were independent predictors of the CTx/osteocalcin ratio in the AN patients. There was a nonlinear association between BMI and the CTx/osteocalcin ratio of r ¼ À0.72 (Po0.001) in the AN patients, but only a weak relation of r ¼ À0.27 (Po0.05) between these parameters in the control subjects. Use of oral contraceptives had no effect on the CTx/ osteocalcin ratio, neither in AN patients nor in controls. Conclusions: Data indicate an uncoupling of bone formation and bone resorption in AN, which is primarily the result of a low BMI and influenced by the duration of the disease.

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Section: Introductionmentioning

confidence: 81%

Section: Correlationsmentioning

confidence: 99%

Body mass index and disease duration are predictors of disturbed bone turnover in anorexia nervosa. A case–control study

et al. 2003

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“…A study of 12 AN patients found that despite weight gain, the patients failed to increase lumbar and neck BMD (Kooh & Noriega, 1996). Thus, weight gain was found to improve bone turnover in AN patients, but did not improve BMD (Caillot-Augusseau et al, 2000;Hotta, Shibasaki, Sato, & Demura, 1998). Therefore, we concluded that the medications employed in our study might improve BMD in AN.…”

Section: Resultsmentioning

confidence: 59%

The effects of bone therapy on tibial bone loss in young women with anorexia nervosa

Nakahara

Nagai

Tanaka

et al. 2006

Int. J. Eat. Disord.

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“…The same applies for u-CTX in another small group of nine AN women after refeeding, although the non-significant decrease in u-CTX was of 40% from baseline. Serum-CTX did indeed decrease significantly, and its circadian variation was restored (Caillot-Augusseau et al, 2000). We observe that urinary excretion of Pyd and Dpd was higher in nutritionally rehabilitated ex-AN patients that were weight stable for at least 6 months than in healthy controls and no different from AN patients.…”

Section: Discussionmentioning

confidence: 64%

“…Only the latter would reflect the early morning peak of the circadian variation in crosslink excretion described in normal adults and children (Fincato et al, 1993;McLaren et al, 1993). In addition, that circadian variation, observed as well for plasma and serum C-telopeptides of collagen type-I, seems to be lost in AN and recovered with weight regain (Caillot-Augusseau et al, 2000), which would limit the use of spot urine samples for comparisons between AN patients before and after rehabilitation, RE subjects and controls.…”

Section: Discussionmentioning

confidence: 98%

Bone resorption in anorexia nervosa and rehabilitated patients

et al. 2003

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Objective: To assess the impact of anorexia nervosa and that of nutritional rehabilitation on bone resorption. Design: Cross-sectional, observational study. Setting: Rome, Italy Subjects: Twenty-eight female patients affected by anorexia nervosa (AN, BMI 17.0 kg=m 2 ), 18 females rehabilitated from anorexia nervosa and weight-stable for at least 6 months (RE, BMI ! 18.5 kg=m 2 ) and 34 age-and sex-matched healthy controls (CO, BMI ! 18.5 kg=m 2 ). Among AN patients, 16 were affected by the 'restrictive' (ANr) and 12 by the 'purging' type (ANp) of anorexia nervosa. Method: Body weight, height and skeletal diameters were measured on each individual. The skeletal mass (SKM) was predicted from the skeletal diameters of the elbow, wrist, knee and ankle, using the equation of Martin. Twenty-four-hour urinary excretion of pyridinium crosslinks of collagen (pyridinoline (Pyd) and deoxypyridinoline (Dpd)) and creatinine was assessed by reversed-phase HPLC with fluorimetric detection after solid-phase extraction and by the Jaffé-method with deproteinization, respectively. Results: Twenty-four-hour urinary output of Pyd and Dpd was not significantly different between AN and CO when expressed in absolute values, but AN showed higher bone resorption than CO when Pyd and Dpd excretion was adjusted by either creatinine (P < 0.0000) or the SKM (P < 0.05). Within the AN group, urinary excretion of both cross-links was significantly and consistently higher in ANp compared with ANr (P < 0.05). However, these differences disappeared when crosslink output was adjusted either by urinary creatinine or SKM. RE subjects showed no differences in bone resorption with the AN group despite weight gain, being crosslink excretion consistently elevated compared to controls (Pyd: P < 0.01 by creatinine and P < 0.05 by SKM; Dpd: P < 0.01 by creatinine and P < 0.05 by SKM). Conclusion: Bone resorption is elevated in anorexia nervosa and different strategies for low-weight maintenance do not seem to have a differential impact. Increased bone resorption persists in subjects with past diagnosis of anorexia nervosa despite rehabilitation lasting more than 6 months. This finding indicates that bone mass and turnover should be monitored in anorexia nervosa patients and ex-patients well beyond recovery of normal body mass. Further investigation is warranted to examine the long-term effect of such prolonged increase in bone turnover at a young age. Sponsorship: Dr. Valtueña is supported by a Marie Curie Fellowship from the European Commission (Contact no. HPMF-CT-1999-00192). European Journal of Clinical Nutrition (2003) 57, 260 -265. doi:10.1038=sj.ejcn.1601527 Keywords: anorexia nervosa; 'purging' anorexia; restrictive anorexia; pyridinoline; deoxypyridinoline; nutritional rehabilitation *Correspondence: F Branca, Human Nutrition Unit, National Institute for Food and Nutrition Research, Via Ardeatina 546, 00179 Roma, Italy. E-mail: f.branca@agora.it Guarantor: Dr. Francesco Branca. Contributors: SV was responsible for the analysis of the data and th...

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Weight gain reverses bone turnover and restores circadian variation of bone resorption in anorexic patients

Abstract: In this study we found that weight gain, related to refeeding only, reversed the anorexia nervosa-induced uncoupling of bone remodelling and restored circadian variation of a bone resorption marker.

Cited by 61 publications

References 35 publications

Body mass index and disease duration are predictors of disturbed bone turnover in anorexia nervosa. A case–control study

Body mass index and disease duration are predictors of disturbed bone turnover in anorexia nervosa. A case–control study

The effects of bone therapy on tibial bone loss in young women with anorexia nervosa

Bone resorption in anorexia nervosa and rehabilitated patients

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