Effects of denosumab on osteoporosis in three cases with anorexia nervosa and a review of the literature

Abstract

Anorexia nervosa (AN) is a psychiatric disorder associated with a high risk of decreased bone mineral density (BMD) and fractures. In recent years, the anti-osteoclastic agent denosumab has become widely adopted for primary and secondary osteoporosis, but the drug’s efficacy for osteoporosis in AN is uncertain. This retrospective, consecutive, case series investigated three osteoporotic cases of AN to examine the effects of denosumab on bone fragility and fracture prevention. Three female patients, respectively, aged 36, 37, and 42 years were diagnosed as having AN and began denosumab treatment for osteoporosis. Bone turnover markers and BMD of the lumbar 1–4 spine (L-BMD) and bilateral hips (H-BMD) were examined before and at 6, 12, 18, and 24 months of therapy. No fractures or severe side effects such as hypocalcemia were observed. All bone turnover markers were strongly decreased and both L-BMD and H-BMD were markedly augmented by denosumab over 24 months. These findings suggest that denosumab is a good option to treat osteoporosis in AN.