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Eating Disorders and Their Effects on Bone Health

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Nutrition and Bone Health

Part of the book series: Nutrition and Health ((NH))

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Abstract

Low-weight eating disorders such as anorexia nervosa (AN) are associated with low bone density, impaired bone structure, and a higher risk for fracture in both adults and adolescents. Factors contributing to low bone density include changes in body composition, hypogonadism, a state of acquired growth hormone resistance with low insulin-like growth factor-1 (IGF-1) levels, relative hypercortisolemia, and changes in other hormones that may impact bone metabolism including leptin, peptide YY, oxytocin, adiponectin, insulin, and amylin. The best strategy to improve bone density and bone accrual rates is weight gain and restoration of menstrual function; however, residual deficits often persist. In addition, a significant number of patients remain low weight for many years. Calcium and vitamin D status should be optimized; however, supplementation of these micronutrients alone is not effective in improving bone density. Physiologic estrogen replacement is effective in increasing bone density at the spine and hip in girls with anorexia nervosa (AN) such that bone accrual rates approximate that in normal-weight controls; however, catch-up does not occur. Bisphosphonates (anti-resorptive) are effective in increasing bone density in adults, but not adolescents with AN. IGF-1 is a bone anabolic hormone, and IGF1 replacement increases bone formation in adolescents, and with estrogen increases bone density in adults with AN. More studies are necessary to determine the best strategies to optimize bone density in AN.

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Authors and Affiliations

  1. Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, BUL 457B, 55 Fruit Street, Boston, MA, 02114, USA

    Madhusmita Misra M.D., M.P.H. & Anne Klibanski M.D.

  2. Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, 02114, USA

    Madhusmita Misra M.D., M.P.H.

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  1. Madhusmita Misra M.D., M.P.H.
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  2. Anne Klibanski M.D.
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Correspondence to Anne Klibanski M.D. .

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  1. Department of Medicine, Physiology, and Biophysics, Boston University Medical Center, Boston, Massachusetts, USA

    Michael F. Holick

  2. Helen Hayes Hospital and Department of Epidemiology, Mailman School of Public Health Institute of Human Nutrition, Columbia University, New York, New York, USA

    Jeri W. Nieves

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Misra, M., Klibanski, A. (2015). Eating Disorders and Their Effects on Bone Health. In: Holick, M., Nieves, J. (eds) Nutrition and Bone Health. Nutrition and Health. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-2001-3_35

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  • DOI: https://doi.org/10.1007/978-1-4939-2001-3_35

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