Osteoporosis International

, Volume 17, Issue 1, pp 77–84

Changes in bone mineral density, body composition and biochemical markers of bone turnover during weight gain in adolescents with severe anorexia nervosa: a 1-year prospective study

  • J. E. Compston
  • C. McConachie
  • C. Stott
  • R. A. Hannon
  • S. Kaptoge
  • I. Debiram
  • S. Love
  • A. Jaffa
Original Article

Abstract

Osteoporosis is a serious complication of anorexia nervosa and in affected adolescents may result in a permanent deficit in bone mass. The pathophysiology of this bone disease has not been clearly defined. In this prospective study of 26 young women with anorexia nervosa aged 13–20 years (mean 16.5) we have measured changes in bone mineral density, total body composition and biochemical indices of bone turnover over 1 year. Over this period there was a mean weight gain of 10 kg and significant height gain with baseline and final values for body mass index of 14.2±1.7 and 17.6±2.3 kg/m2 (P<0.001). However, no significant changes were seen in bone mineral density in the spine or proximal femur during the study; total body bone mineral content was significantly higher than baseline at 3 months and 12 months (P=0.001 and P<0.0001), but total body bone mineral density at 3 months was significantly lower than baseline (P=0.003). Serum osteocalcin and bone-specific alkaline phosphatase values increased significantly and remained higher than baseline at all time points whereas urinary NTX/creatinine excretion showed a non-significant increase over the first 6 months of the study, but at 12 months, the mean value was significantly lower than baseline. Mean serum 25-hydroxyvitamin D levels showed a significant decrease at 6 months (P<0.05), but returned towards baseline thereafter. There was a significant increase in serum parathyroid hormone levels at all time points compared to baseline, these occurring within the normal range. These results indicate that although weight gain in young anorexics is associated with linear growth, bone mineral density does not increase. Whether this deficit can be corrected subsequently requires longer-term prospective studies.

Keywords

Anorexia nervosa Body composition Bone mineral density Osteoporosis 

References

  1. 1.
    Rigotti NA, Nussbaum SR, Herzog DB, Neer RM (1984) Osteoporosis in women with anorexia nervosa. New Engl J Med 311:1601–1606PubMedCrossRefGoogle Scholar
  2. 2.
    Biller BMK, Saxe V, Herzog DB, Rosenthal DI, Holzman S, Klibanski A (1989) Mechanisms of osteoporosis in adult and adolescent women with anorexia nervosa. J Clin Endocrinol Metab 68:548–554PubMedGoogle Scholar
  3. 3.
    Bachrach LK, Guido D, Katzmann D, Litt IF, Marcus M (1990) Decreased bone density in adolescent girls with anorexia nervosa. Pediatrics 86:440–447PubMedGoogle Scholar
  4. 4.
    Mehler PS (2003) Osteoporosis in anorexia nervosa: prevention and treatment. Int J Eating Disorders 33:113–126CrossRefGoogle Scholar
  5. 5.
    Bachrach LK, Katzmann DK, Litt IF, Guido D, Marcus R (1991) Recovery from osteopenia in adolescent girls with anorexia nervosa. J Clin Endocrinol Metab 72:602–606PubMedGoogle Scholar
  6. 6.
    Seeman E, Szmuckler GI, Formica C, Tsalamandris C, Mestrovic R (1992) Osteoporosis in anorexia nervosa: the influence of peak bone density, bone loss, oral contraceptive use, and exercise. J Bone Miner Res 7:1467–1474PubMedADSGoogle Scholar
  7. 7.
    Herzog W, Minne H, Deter C et al (1993) Outcome of bone mineral density in anorexia nervosa patients 11.7 years after first admission. J Bone Miner Res 8:597–605PubMedCrossRefGoogle Scholar
  8. 8.
    Grinspoon S, Thomas E, Pitts S et al (2000) Prevalence and predictive factors for regional osteopenia in women with anorexia nervosa. Ann Intern Med 133:790–794PubMedGoogle Scholar
  9. 9.
    Castro J, Lazaro L, Pons F, Halperin I, Toro J (2000) Predictors of bone mineral density reduction in adolescents with anorexia nervosa. J Am Acad Child Adolesc Psych 39:1365–1370CrossRefGoogle Scholar
  10. 10.
    Hartmann D, Crisp A, Rooney B, Trackow C, Atkinson R, Patel S (2000) Bone density of women who have recovered from anorexia nervosa. Int J Eating Disorders 28:107–112CrossRefGoogle Scholar
  11. 11.
    Valla Å, Groenning IL, Syversen U, Hoeiseth A (2000) Anorexia nervosa: slow regain of bone mass. Osteoporos Int 11:141–145PubMedCrossRefGoogle Scholar
  12. 12.
    Turner JM, M.K. B, McDermott BM, Byrne GC, Prince RL, Forbes DA (2001) Predictors of low bone density in young adolescent females with anorexia nervosa and other dieting disorders. Int J Eating Disorders 30:245–251CrossRefADSGoogle Scholar
  13. 13.
    Wentz E, Mellström D, Gillberg C, Sundh V, Gillberg IC, Rastam M (2003) Bone density 11 years after anorexia nervosa onset in a controlled study of 39 cases. Int J Eating Disorders 34:314–318CrossRefGoogle Scholar
  14. 14.
    Misra M, Miller KK, Bjornson J et al (2003) Alterations in growth hormone secretory dynamics in adolescent girls with anorexia nervosa and effects on bone metabolism. J Clin Endocrinol Metab 88:5615–5623CrossRefPubMedGoogle Scholar
  15. 15.
    Soyka LA, Grinspoon S, Levitsky LL, Herzog DB, Klibanski A (1999) The effects of anorexia nervosa on bone metabolism in female adolescents. J Clin Endocrinol Metab 84:4489–4496CrossRefPubMedGoogle Scholar
  16. 16.
    Soyka LA, Misra M, A. F, Miller KK, Grinspoon S, Schoenfeld DA, Klibanski A (2002) Abnormal bone mineral accrual in adolescent girls with anorexia nervosa. J Clin Endocrinol Metab 87:4177–4185CrossRefPubMedGoogle Scholar
  17. 17.
    Hannan WJ, Tothill P, Cowen SJ, Wrate RM (1998) Whole body bone mineral content in healthy children and adolescents. Arch Dis Child 78:396PubMedCrossRefGoogle Scholar
  18. 18.
    Klibanski A, Biller BMK, Schoenfeld DA, Herzog DB, Saxe VC (1995) The effects of estrogen administration on trabecular bone loss in young women with anorexia nervosa. J Clin Endocrinol Metab 80:898–904CrossRefPubMedGoogle Scholar
  19. 19.
    Baker DI, Roberts R, Towell T (2000) Factors predictive of bone mineral density in eating-disordered women: a longitudinal study. Int J Eating Disorders 27:29–35CrossRefGoogle Scholar
  20. 20.
    Gordon CM, Grace E, Emans SJ et al (2002) Effects of oral dehydroepiandrosterone on bone density in young women with anorexia nervosa: a randomised trial. J Clin Endocrinol Metab 87:4935–4941CrossRefPubMedGoogle Scholar
  21. 21.
    Rigotti NA, Neer RM, Skates SJ, Herzog DB, Nussbaum SR (1991) The clinical course of osteoporosis in anorexia nervosa. A longitudinal study of cortical bone mass. JAMA 265:1133–1138CrossRefPubMedGoogle Scholar
  22. 22.
    Manzoni P, Brambilla P, Pietrobelli A et al (1996) Influence of body composition on bone mineral content in children and adolescents. Am J Clin Nutr 64:603–607PubMedGoogle Scholar
  23. 23.
    Seeman E, Karlsson MK, Duan Y (2000) On exposure to anorexia nervosa, the temporal variation in axial and appendicular skeletal development predisposes to site-specific deficits in bone size and density: a cross-sectional study. J Bone Miner Res 15:2259–2265PubMedCrossRefGoogle Scholar
  24. 24.
    Bonjour JP, Theintz G, Buchs B, Slosman D, Rizzoli R (1991) Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence. J Clin Endocrinol Metab 73:555–563PubMedCrossRefGoogle Scholar
  25. 25.
    Theintz G, Buchs B, Rizzoli R et al (1992) Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab 75:1060–1065CrossRefPubMedGoogle Scholar
  26. 26.
    Bonjour J-P, Rizzoli R (1996) Bone acquisition in adolescence. In: Marcus R, Feldman D, Kelsey J (eds) Osteoporosis. Academic Press, San Diego, pp 465–476Google Scholar
  27. 27.
    Dempster DW, Zhou H, Cosman F et al (2001) PTH treatment directly stimulates bone formation in cancellous and cortical bone in humans. J Bone Miner Res 16:S179CrossRefGoogle Scholar
  28. 28.
    Blumsohn A, Hannon RA, Wrate R et al (1994) Biochemical markers of bone turnover in girls during puberty. Clin Endocrinol 40:663–670CrossRefGoogle Scholar
  29. 29.
    Mora S, Prinster C, Proverbio MC et al 1998 Urinary markers of bone turnover in healthy children and adolescents: age-related changes and effect of puberty. Calcif Tissue Int 63:369–374Google Scholar
  30. 30.
    Johnston CC, Miller JZ, Slemenda CW et al (1992) Calcium supplementation and increases in bone mineral density in children. New Engl J Med 327:82–87PubMedCrossRefGoogle Scholar
  31. 31.
    Lloyd T, Andon MB, Rollings N et al (1993) Calcium supplementation and bone mineral density in adolescent girls. JAMA 270:841–844CrossRefPubMedGoogle Scholar
  32. 32.
    Martin AD, Bailey DA, McKay H, Whiting SJ (1997) Bone mineral and calcium accretion during puberty. Am J Clin Nutr 66:611–615PubMedADSGoogle Scholar
  33. 33.
    Gordon CM, Grace E, Emans SJ, Goodman E, Crawford MH, Leboff MS (1999) Changes in bone turnover markers and menstrual function after short-term oral DHEA in young women with anorexia nervosa. J Bone Miner Res 14:136–145PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • J. E. Compston
    • 1
    • 9
  • C. McConachie
    • 2
  • C. Stott
    • 3
  • R. A. Hannon
    • 4
  • S. Kaptoge
    • 5
  • I. Debiram
    • 6
  • S. Love
    • 7
  • A. Jaffa
    • 8
  1. 1.Department of MedicineUniversity of Cambridge School of Clinical MedicineCambridgeUK
  2. 2.The Croft Children’s UnitCambridgeUK
  3. 3.Department of Developmental PsychiatryDouglas HouseCambridgeUK
  4. 4.Academic Unit of Bone MetabolismUniversity of SheffieldSheffieldUK
  5. 5.Bone Research GroupStrangeways Research LaboratoryCambridgeUK
  6. 6.Department of MedicineAddenbrooke’s HospitalCambridgeUK
  7. 7.Metabolic Bone UnitAddenbrooke’s HospitalCambridgeUK
  8. 8.The Phoenix CentreCambridgeUK
  9. 9.Department of MedicineAddenbrooke’s HospitalCambridgeUK

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