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Bone mass and biomarkers in young women with anorexia nervosa: a prospective 3-year follow-up study

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Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Introduction

Anorexia nervosa (AN) increases the risk of impaired bone health, low areal bone mineral density (aBMD), and subsequent fractures. This prospective study investigated the long-term effects of bone and mineral metabolism on bone and biomarkers in 22 women with AN.

Materials and methods

Body composition and aBMD were measured by dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography. Total and free 25-hydroxyvitamin D (25OHD), C-terminal collagen cross-links (CTX), osteocalcin, bone-specific alkaline phosphatase (BALP), leptin, sclerostin, and oxidized/non-oxidized parathyroid hormone (PTH) were analyzed before and after 12 weeks of intensive nutrition therapy and again 3 years later. An age-matched comparison group of 17 healthy women was recruited for the 3-year follow-up.

Results

Body mass index (BMI) and fat mass increased from baseline to 3 years in women with AN. Sclerostin decreased during nutrition therapy and further over 3 years, indicating reduced bone loss. CTX was elevated at baseline and after 12 weeks but decreased over 3 years. BALP increased during nutrition therapy and stabilized over 3 years. Free 25OHD was stable during treatment but decreased over 3 years. Non-oxidized PTH was stable during treatment but increased over 3 years. Trabecular volumetric BMD in AN patients decreased during the first 12 weeks and over 3 years despite stable BMI and bone biomarkers implying increased BMD.

Conclusion

Our findings highlight the importance of early detection and organized long-term follow-up of bone health in young women with a history of AN.

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Acknowledgements

We thank the participating women for their enthusiasm and patience, and the staff of the Eating Disorder Inpatient Unit at Queen Silvia Children’s Hospital. We acknowledge the expert assistance of Anne Dohsé and would like to thank Hussein Hamoodi, Nils-Gunnar Pehrsson, and Aldina Pivodic for their expert statistical advice. We are grateful to Evelina Granlund, Diana Atanasova, and Anette Ekberg for their assistance. This study was supported by grants from the Queen Silvia Children’s Hospital Research Foundation, ALF grants from Region Östergötland, the Capio Foundation, the Samariten Foundation, HKH Princess Lovisa’s Foundation, Sahlgrenska University Hospital, and the Health and Medical Care Committee of the Regional Executive Board of Region Västra Götaland, and by grants from the Swedish state under the ALF agreement between the Swedish government and the county councils (ALFGBG-716831, 678871, 965009, and 117661). These funding sources had no involvement in the study design, the collection, analysis, and interpretation of data, writing of the report, or the decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Anna Svedlund, Anders Elfvin & Diana Swolin-Eide

  2. Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children’s Hospital, Department of Pediatrics, Gothenburg, Sweden

    Anna Svedlund, Anders Elfvin & Diana Swolin-Eide

  3. Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Cecilia Pettersson & Lars Ellegård

  4. Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Bojan Tubic

  5. Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

    Per Magnusson

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  1. Anna Svedlund
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  2. Cecilia Pettersson
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  7. Diana Swolin-Eide
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Contributions

AS: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, visualization, writing—original draft, review and editing. CP: conceptualization, data curation, investigation, project administration, writing—review and editing. BT: data curation, funding acquisition, writing—review and editing. LE: conceptualization, methodology, writing—review and editing. AE: funding acquisition, Writing—review and editing. PM: conceptualization, formal analysis, funding acquisition, methodology, supervision, writing—review and editing. DSE: conceptualization, formal analysis, funding acquisition, methodology, supervision, writing—review and editing.

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Correspondence to Anna Svedlund.

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Svedlund, A., Pettersson, C., Tubic, B. et al. Bone mass and biomarkers in young women with anorexia nervosa: a prospective 3-year follow-up study. J Bone Miner Metab 40, 974–989 (2022). https://doi.org/10.1007/s00774-022-01359-x

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  • DOI: https://doi.org/10.1007/s00774-022-01359-x

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