Abstract
BackgroundEarly-onset anorexia nervosa (EO-AN) represents a significant clinical burden to paediatric and mental health services. The impact of EO-AN on bone mineral abnormalities has not been thoroughly investigated due to inadequate control for pubertal status. In this study, we investigated bone mineral abnormalities in girls with EO-AN regardless of pubertal development stage.MethodWe conducted a cross-sectional study of 67 girls with EO-AN (median age = 12.4 [10.9–13.7 years]) after a median duration of disease of 1.3 [0.6–2.0] years, and 67 healthy age-, sex-, pubertal status- matched control subjects. We compared relevant bone mineral parameters between groups: the total body bone mineral density [TB-BMD], the lumbar spine BMD [LS-BMD], the total body bone mineral content [TB-BMC] and the ratio of the TB-BMC to lean body mass [TB-BMC/LBM].ResultsTB-BMD, TB-BMC, LS-BMD and TB-BMC/LBM were all significantly lower in patients with AN compared to controls. In the EO-AN group, older age, later pubertal stages and higher lean body mass were associated with higher TB-BMC, TB-BMD, and LS-BMD values.DiscussionGirls with EO-AN displayed deficits in bone mineral content and density after adjustment for pubertal maturation. Age, higher pubertal stage and lean body mass were identified as determinants of bone maturation in the clinical population of patients with EO-AN. Bone health should be promoted in patients, specifically in those with an onset of disorder before 14 years old and with a delayed puberty.
Highlights
Early-onset anorexia nervosa (EO-Anorexia nervosa (AN)) represents a significant clinical burden to paediatric and mental health services
Total Body Bone Mineral Density (TB-BMD), Total Body Bone Mineral Content (TB-BMC), lumbar spine (LS)-BMD and total body (TB)-BMC/Lean Body Mass (LBM) were all significantly lower in patients with AN compared to controls
In the Early-onset anorexia nervosa (EO-AN) group, older age, later pubertal stages and higher lean body mass were associated with higher TB-BMC, TB-BMD, and LS-BMD values
Summary
Early-onset anorexia nervosa (EO-AN) represents a significant clinical burden to paediatric and mental health services. More than 50% of adolescents with AN have a BMD more than one standard deviation lower than the mean for age, and approximately 10% of these adolescents have BMD values more than two standard deviations below the mean [14] This negative effect of the disease on bone health has been found to persist 5 to 10 years after recovery from a severely low BMI at adolescence [15]. Bone acquisition in late childhood is influenced mostly by pubertal stage and growth-related changes in body and skeleton size (including age, height and weight) [21]. During puberty, both nutritional and hormonal factors play major roles in the process of bone development. Peak bone mass gain generally occurs in late puberty, with BMD values increasing up to Tanner stage 4 [22]
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