Original article| Volume 37, ISSUE 8, P521-527, April 15, 1995

Effects of weight gain and resumption of menses on reduced bone density in patients with anorexia nervosa

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      The bone mineral density (BMD) of the lumbar vertebrae (L2–L4) and of the whole body were measured in cross-sectional and longitudinal studies in female patients with eating disorders, using dual photon absorptiometry before and after weight gain with or without resumption of menses.
      In the cross-sectional study, the low-body-weight anorectic patients, with or without bulimia nervosa, were found to have lower BMD of the lumbar vertebrae associated with severe weight loss, low physical activity, and earlier onset and longer duration of amenorrhea.
      In the longitudinal study, 11 patients attained subnormal body weight (70%SBW ≦ ∼ < 85% SBW), 10 patients attained normal body weight (≧ 85%SBW, 6 patients of them resumed regular menses) after treatment. The BMD of the lumbar vertebrae was found to increase with weight gain, but not to the control level. The BMD was further increased with the resumption of menses in patients with anorexia nervosa. These results suggest that resumption of menses, in addition to weight gain, is essential to normalize reduced bone mineral density.

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        • Ayers JWT
        • Gidwani GP
        • Schmidt IMV
        • Gross M
        Osteopenia in hypoestrogenic young women with anorexia nervosa.
        Fertil Steril. 1984; 41: 224-228
        • Bachrach LK
        • Guido D
        • Katzman D
        • Litt IF
        • Marcus R
        Decreased bone density in adolescent girls with anorexia nervosa.
        Pediatrics. 1990; 86: 440-447
        • Bachrach LK
        • Katzman D
        • Litt IF
        • Guido D
        • Marcus R
        Recovery from osteopenia in adolescent girls with anorexia nervosa.
        J Clin Endocrinol Metab. 1991; 72: 602-606
        • Biller BMK
        • Saxe V
        • Herzog DB
        • Rosenthal DI
        • Haizman S
        • Klibanski A
        Mechanism of osteoporosis in adult and adolescent women with anorexia nervosa.
        J Clin Endocrinol Metab. 1989; 68: 548-554
        • Brotman AW
        • Stern TA
        Osteoporosis and pathologic fracture in anorexia nervosa.
        Am J Psychiatry. 1985; 142: 495-496
        • Crosby LO
        • Kaplan FS
        • Pertschuk MJ
        • Mullen JI
        The effect of anorexia nervosa on bone morphometry in young women.
        Clin Orthop. 1985; 201: 271-272
        • Davies KM
        • Pearson PH
        • Museman CA
        • Greger NG
        • Kimmel DK
        • Recker RR
        Reduced bone mineral in patients with eating disorders.
        Bone. 1990; 11: 143-147
        • Hay PJ
        • Hall A
        • Delahunt JW
        • Harper G
        • Mitchell AW
        • Salmond C
        Investigation of osteopenia in anorexia nervosa.
        Aust N Z T Psychiatry. 1989; 23: 261-268
        • Howat PM
        • Varner LM
        • Hegsted M
        • Brewer MM
        • Mills GQ
        The effect of bulimia upon diet, body fat, bone density, and blood component.
        J Am Diet Assoc. 1989; 89: 929-934
        • Jones KP
        • Ravnikar VA
        • Tulchinsky D
        • Schiff I
        Comparison of bone density in amenorrheic women due to athletics, weight loss, and premature menopause.
        Obstet Gynecol. 1985; 66: 5-8
        • Joyce JM
        • Warren DL
        • Humphries LL
        • Smith AJ
        • Coon JS
        Osteoporosis in women with eating disorders: comparison of physical parameters, exercise, and menstrual status with SPA and DPA evaluation.
        J Nucl Med. 1990; 31: 325-331
        • Kaplan FS
        • Pertschuk M
        • Fallo M
        • Haddad J
        Osteoporosis and hip fracture in young women with anorexia nervosa.
        Clin Orthop. 1986; 212: 250-254
        • Kiriike N
        • Iketani T
        • Nakanishi S
        • et al.
        Reduced bone density and major hormones regulating calcium metabolism in anorexia nervosa.
        Acta Psychiatr Scand. 1992; 86: 358-363
        • Lam SY
        • Evans JH
        • Quinn MA
        • Baker HWG
        Postpartum signal wedge fracture in a 27-year-old epileptic anorectic woman.
        Aust N Z J Obstet Gynaecol. 1987; 27: 71-74
      1. (0000)
        • Mazess RB
        • Cameron JR
        Bone mineral content in normal U.S. whites.
        in: Mazess RB International Conference on Bone Mineral Measurement. HEW, Washington DC1974
        • Mazess RB
        • Barden HS
        • Ohlrich ES
        Skeletal and bodycomposition effects of anorexia nervosa.
        Am J Clin Nutr. 1990; 52: 438-441
        • McAnarney ER
        • Greydanus DE
        • Campanella VA
        • Hoekelman RA
        Rib fractures and anorexia nervosa.
        J Adolesc Health Care. 1983; 4: 40-43
        • Newman MM
        • Halmi KA
        Relationship of bone density to estradiol and cortisol in anorexia nervosa and bulimia.
        Psychiatry Res. 1989; 29: 105-112
        • Passloff ES
        • Slap GB
        • Pertschuk MJ
        • Attie MF
        • Kaplan F
        A longitudinal study of metacarpal bone morphometry in anorexia nervosa.
        Clin Orthop. 1992; 278: 217-225
        • Rigotti NA
        • Nussbaum SR
        • Herzog DB
        • Neer RM
        Osteoporosis in women with anorexia nervosa.
        N Engl J Med. 1984; 311: 1601-1606
        • Rigotti NA
        • Neer RM
        • Jameson L
        Osteopenia and bone fractures in a man with anorexia nervosa and hypogonadism.
        JAMA. 1986; 256: 385-388
        • Rigotti NA
        • Neer RM
        • Skates SJ
        • Herzog DB
        • Nussbaum SR
        The clinical course of osteoporosis in anorexia nervosa.
        JAMA. 1991; 265: 1133-1138
        • Rüegsgger P
        • Müller A
        • Dambacher MA
        • Ittner J
        • Willi J
        • Kopp HG
        Knochenabbau bei Patientinnen mit Anorexia nervosa.
        Schweiz Med Wschr. 1988; 118: 233-238
        • Savvas M
        • Treasure J
        • Studd J
        • Fogelman I
        • Moniz C
        • Brincat M
        The effect of anorexia nervosa on skin thickness, skin collagen and bone density.
        Br J Obstet Gynaecol. 1989; 96: 1392-1394
        • Szmukler GI
        • Brown SW
        • Parsons V
        • Darby A
        Premature loss of bone in chronic anorexia nervosa.
        Br Med J. 1985; 290: 26-27
        • Treasure JL
        • Russel GF
        • Fogelman I
        • Murby B
        Reversible bone loss in anorexia nervosa.
        Br Med J. 1987; 295: 474-475