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| |  DG DISPATCH - ENDO 99: Anorexia Nervosa Linked To Serious Bone Loss By Cameron Johnston Special to DG News SAN DIEGO, CA -- June 17, 1999 -- Besides a host of medical problems ranging from amenorrhea (cessation of monthly periods), opportunistic infections and the increased risk of suicide, Harvard Medical School doctors now report that young girls with anorexia nervosa are also susceptible to significant loss in bone mineral density (BMD). The researchers say the loss of BMD seen in a small group of girls averaging 19 years of age was significant and could put them at risk for skeletal problems such as spine deformations, increased risk of fractures and perhaps osteoporosis. These findings were presented at the annual meeting of the Endocrine Society which wrapped up in San Diego yesterday. Neuroendocrinologists at Harvard and in the Massachusetts General Hospital eating disorders clinic examined 14 girls with anorexia of a mean duration of 14 months. Their biochemical markers were compared with a group of 27 age-matched controls. The girls underwent bone scans and were evaluated as to bone age and pubertal status (bone age is an indicator of bone strength and maturity). Females are normally considered mature at the age of 15 to 16, whereas males age slightly later, around the age of 17 to 18. The researchers divided the girls into two groups: 11 whose bone age was greater than 15 years; and three with bone age of less than 15 years. Not surprisingly, researchers found that body mass index (BMI), lean body mass and fat mass were all significantly lower in mature bone age anorexics compared with the control group. The girls whose bone age was normal were also considered to be in late puberty, while 30 percent of those who had an immature bone age were considered to be immature sexually, with small breast development. The researchers also found that anorexics in the mature bone age group had significantly lower BMDs in the lumbar spine and lateral spine than those in the control group. The total body BMD was also lower in the mature bone age group, but not statistically different, researchers said. In the immature bone age group, total BMI and total fat mass were significantly lower than in the control group, but their lean mass index was not different. Interestingly, the number of anorexic girls who were calcium deficient was not significantly greater than the controls who were lacking in calcium (77 percent versus 64 percent). Furthermore, there were actually more controls with deficiency of vitamin D (92 percent) compared with the anorexic study group, where only 85 percent were vitamin D deficient. The researchers also pointed out that the body’s fat content did not correlate with the likelihood of them losing BMD, whereas the body’s lean mass did. Researchers said that based on biochemical markers that are excreted in the urine, it appears that the bone loss in anorexic girls is caused by a lack of bone formation rather than any abnormality in bone resorption. Researchers added that the majority of young girls are deficient in both calcium and vitamin D during puberty when these nutrients are needed most. Researchers concluded that this study doesn’t allow them to make any hard and fast predictions about BMD in girls with anorexia. However, they maintain that bone age and pubertal stage are closely correlated in healthy adolescent girls, but not in anorexic subjects. Therefore, they conclude that bone age might be a better index of maturation than pubertal stage in these subjects.
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