J Bone Metab.  2019 Aug;26(3):133-143. 10.11005/jbm.2019.26.3.133.

Anorexia Nervosa and Osteoporosis: Pathophysiology and Treatment

• Steinman J
• Shibli-Rahhal A

• KMID: 2457432
• DOI: http://doi.org/10.11005/jbm.2019.26.3.133

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.

Keyword

Anorexia; Bone density; Feeding and eating disorders; Osteoporosis

MeSH Terms

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
Diphosphonates
Growth Hormone
Leptin
Teriparatide

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