Abstract
Background and aimsThere still is a lack of prospective studies on bone mineral development in patients with a history of early onset Anorexia nervosa (AN). Therefore we assessed associations between bone mass accrual and clinical outcomes in a former clinical sample. In addition to an expected influence of regular physical activity and hormone replacement therapy, we explored correlations with nutritionally dependent hormones.Methods3-9 years (mean 5.2 ± 1.7) after hospital discharge, we re-investigated 52 female subjects with a history of early onset AN. By means of a standardized approach, we evaluated the general outcome of AN. Moreover, bone mineral content (BMC) and bone mineral density (BMD) as well as lean and fat mass were measured by dual-energy x-ray absorptiometry (DXA). In a substudy, we measured the serum concentrations of leptin and insulin-like growth factor-I (IGF-I).ResultsThe general outcome of anorexia nervosa was good in 50% of the subjects (BMI ≥ 17.5 kg/m2, resumption of menses). Clinical improvement was correlated with BMC and BMD accrual (χ2 = 5.62/χ2 = 6.65, p = 0.06 / p = 0.036). The duration of amenorrhea had a negative correlation with BMD (r = -.362; p < 0.01), but not with BMC. Regular physical activity tended to show a positive effect on bone recovery, but the effect of hormone replacement therapy was not significant. Using age-related standards, the post-discharge sample for the substudy presented IGF-I levels below the 5th percentile. IGF-I serum concentrations corresponded to the general outcome of AN. By contrast, leptin serum concentrations showed great variability. They correlated with BMC and current body composition parameters.ConclusionsOur results from the main study indicate a certain adaptability of bone mineral accrual which is dependent on a speedy and ongoing recovery. While leptin levels in the substudy tended to respond immediately to current nutritional status, IGF-I serum concentrations corresponded to the individual's age and general outcome of AN.
Highlights
Background and aimsThere still is a lack of prospective studies on bone mineral development in patients with a history of early onset Anorexia nervosa (AN)
We investigated possible interactions between bone mineral parameters and nutritionally dependent hormones in a subgroup of 39 individuals to test the possible impact of nutritional status on bone development
In a study on 24 adolescent patients with AN, Wong et al found significant correlations between lean mass and bone mineral content (BMC)/bone mineral density (BMD), but no reduced bone mass [65], whereas our results clearly indicate that BMC decisively developed a deficiency in relation to LBM. (This observation is independent of z-scores or t-scores based on any suitable reference population.)
Summary
There still is a lack of prospective studies on bone mineral development in patients with a history of early onset Anorexia nervosa (AN). We assessed associations between bone mass accrual and clinical outcomes in a former clinical sample. Its specific psychopathology occurs at critical periods for bone growth and mineral accrual [1]. BMD determination alone is not adequate for assigning the labels “osteopenia” and “osteoporosis” (as per WHO guidelines). In this age group, labeling of changes should use terms like “poor bone mass accumulation” or “reduced bone mass”. Patients themselves may be better controls for follow-up examinations than age- and sexmatched healthy individuals [11]
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