Chapter Ten - Clinical and Hormonal Variables Related to Bone Mass Loss in Anorexia Nervosa Patients

Abstract

A better understanding of the prognostic factors of low bone mass in anorexia nervosa (AN) and development of effective therapeutic strategies is critical. In order to determine which clinical, biochemical, and/or hormonal parameters could be related to bone mineral density (BMD), 47 female AN patients were classified according to the WHO osteoporosis criteria at lumbar spine (LS). This was a cross-sectional study of 16 AN women with osteoporosis criteria and 31without. Control group was 25 healthy, normal-weight, age-matched women. We assessed BMD using dual-energy X-ray absorptiometry at the LS and body composition. We measured serum fasting cortisol, estradiol, insulin-like growth factor-1 (IGF-1), leptin, sex hormone-binding globulin, albumin and retinol binding protein levels. The prevalence of osteoporosis was 34% and osteopenia 19% at the LS. The AN group with osteoporosis had lower IGF-1 and estradiol levels (both p<0.001), lower serum leptin (p<0.02), and higher cortisolemia (p<0.03) levels compared with AN group without osteoporosis. The BMD and T-score at LS was inversely related to the duration of amenorrhea (p<0.02) and directly related to body mass index (BMI, p<0.002), total fat mass (p<0.03), serum IGF-1 (p<0.01), and estradiol levels (p<0.001) in AN patients. We conclude that AN women with a significant BMD loss have a high risk of developing osteoporosis. A low BMD is a consequence of hormonal alterations which include hypoestrogenism, hypoleptinemia, hypercortisolism, and decreases in IGF-1 levels, as well as a low BMI and fat mass.