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REPLY
Regional Osteoporosis in Anorexia Nervosa
Steven Grinspoon, MD, and
Anne Klibanski, MD
6 November 2001 | Volume 135 Issue 9 | Page 844
IN RESPONSE:
We agree with Dr. Mehler's comments. We have previously shown that leptin levels are tightly regulated by adipose tissue in women with the restricting subtype of anorexia nervosa (1). Recently, Ducy and colleagues (2) demonstrated that leptin itself may inhibit bone formation through central mechanisms in leptin-deficient and wild-type mice. In women with anorexia nervosa, we have found that low leptin levels are associated with osteopenia and osteoporosis (1). Therefore, we believe that in this population, leptin is more likely to be a marker of fat loss and generalized undernutrition than a determinant of bone density. We agree with Dr. Mundy (3) and with Dr. Mehler that bone loss in patients with anorexia nervosa is multifactorial and may be due to hormonal, nutritional, and other variables. Furthermore, we agree that our cross-sectional data and data from previous longitudinal studies (4) suggest that estrogen therapy is not sufficient to restore bone density in women with anorexia nervosa. The minimal effects of estrogen are probably related to the fact that bone loss in women with anorexia nervosa is the result not only of estrogen deficiency but of nutritional deficiencies, which may contribute independently to bone loss. We agree that although bisphosphonates have never been tested in patients with anorexia nervosa, further research is necessary to determine whether they may be effective in preventing bone loss.
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Author and Article Information
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Harvard Medical School; Boston, MA 02114 (Grinspoon, Klibanski)
1. Grinspoon S, Gulick T, Askari H, Landt M, Lee K, Anderson E, et al. Serum leptin levels in women with anorexia nervosa J Clin Endocrinol Metab. 1996;81:3861-3. [PMID: 8923829].
2. Ducy P, Amling M, Takeda S, Priemel M, Schilling AF, Beil FT, et al. Leptin inhibits bone formation through a hypothalamic relay: a central control of bone mass Cell. 2000;100:197-207. [PMID: 10660043].
3. Mundy GR. Secondary osteoporosis: the potential relevance of leptin and low body weight [Editorial] Ann Intern Med. 2000;133:828-30. [PMID: 11085846].
4. Klibanski A, Biller BM, Schoenfeld DA, Herzog DB, Saxe VC. The effects of estrogen administration on trabecular bone loss in young women with anorexia nervosa J Clin Endocrinol Metab. 1995;80:898-904. [PMID: 7883849].
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- Annals 2000 133: 790-794.
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