Anorexia Nervosa and Osteoporosis: Pathophysiology and Treatment
10.11005/jbm.2019.26.3.133
- Author:
Jeremy STEINMAN
1
;
Amal SHIBLI-RAHHAL
Author Information
1. Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. Amal-rahhal@uiowa.edu
- Publication Type:Review
- Keywords:
Anorexia;
Bone density;
Feeding and eating disorders;
Osteoporosis
- MeSH:
Anorexia Nervosa;
Anorexia;
Body Weight;
Bone Density;
Bone Diseases;
Diphosphonates;
Disease Management;
Feeding and Eating Disorders;
Gonads;
Growth Hormone;
Humans;
Leptin;
Osteoporosis;
Teriparatide;
Weight Gain
- From:Journal of Bone Metabolism
2019;26(3):133-143
- CountryRepublic of Korea
- Language:English
-
Abstract:
Anorexia nervosa (AN) affects 2.9 million people, many of whom experience bone loss and increased fracture risk. In this article, we review data on the underlying pathophysiology of AN-related osteoporosis and possible approaches to disease management. Available research suggests that low body weight and decreased gonadal function are the strongest predictors of bone loss and fractures in patients with AN. Additionally, other metabolic disturbances have been linked to bone loss, including growth hormone resistance, low leptin concentrations, and hypercortisolemia, but those correlations are less consistent and lack evidence of causality. In terms of treatment of AN-related bone disease, weight gain has the most robust impact on bone mineral density (BMD). Restoration of gonadal function seems to augment this effect and may independently improve BMD. Bisphosphonates, insulin-like growth factor 1 supplementation, and teriparatide may also be reasonable considerations, however need long-term efficacy and safety data.
