HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dominguez, J. Articles by Warren, M. P Search for Related Content PubMed PubMed Citation Articles by Dominguez, J. Articles by Warren, M. P Agricola Articles by Dominguez, J. Articles by Warren, M. P

Treatment of anorexia nervosa is associated with increases in bone mineral density, and recovery is a biphasic process involving both nutrition and return of menses^1,2,3

¹ From the Departments of Obstetrics and Gynecology (JD, LG, SSG, and MPW), Psychiatry (BTW), and Medicine (MPW and RP), Columbia University Medical Center, New York, NY; New York State Psychiatric Institute, New York, NY (BTW, LM, and SFE); and St Luke's–Roosevelt Hospital Center, New York, NY (RP and JW)

Background: Recovery from osteoporosis in anorexia nervosa (AN) is uncertain.

Objective: The purpose of this study was to understand the changes in bone mineral density (BMD) in women with AN and the mechanisms of recovery from osteopenia.

Design: We studied BMD and markers of bone formation and resorption, osteocalcin and N-telopeptide (NTX), in patients with AN (n = 28) who were following a behavioral weight-gain protocol.

Results: Anorexic patients experienced significant percentage increases in BMD (4.38 ± 7.48% for spine; 3.77 ± 8.8% for hip; P < 0.05 for both) from admission until recovery of 90% ideal body weight, achieved over 2.2 mo. NTX concentrations were higher in patients with AN at admission than in healthy control subjects (n =11; 69.0 ± 31.09 and 48.3 ± 14.38 nmol/mmol creatinine, respectively; P < 0.05) and in reference control subjects (n = 30; 69.0 ± 31.09 and 37.0±6.00 nmol/mmol creatinine, respectively; P < 0.001). In weight-recovered subjects with AN, osteocalcin increased (from 8.0 ± 3.05 to 11.2 ± 6.54 ng/mL; P < 0.05), whereas NTX remained elevated (from 69.0 ± 31.09 to 66.7 ± 45.5 nmol/mmol creatinine; NS). A decrease in NTX (from 70.7 ± 40.84 to 45.9 ± 22.72 nmol/mmol creatinine; NS) occurred only in the subgroup of subjects who regained menses with weight recovery.

Conclusions: Nutritional rehabilitation induces a powerful anabolic effect on bone. However, a fall of NTX and a shift from the dominant resorptive state, which we postulate involves full recovery, may involve a hormonal mechanism and require a return of menses. Nutritional rehabilitation appears to be critical to bone recovery and may explain the ineffectiveness of estrogen treatment alone on BMD in the cachectic state.

Key Words: Anorexia nervosa • bone mineral density • osteopenia • amenorrhea • bone markers