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Prevalence and Predictive Factors for Regional Osteopenia in Women with Anorexia Nervosa
- Steven Grinspoon, MD;
- Elizabeth Thomas, NP;
- Sarah Pitts, BA;
- Erin Gross, BA;
- Diane Mickley, MD;
- Karen Miller, MD;
- David Herzog, MD; and
- Anne Klibanski, MD
- From Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and the Wilkins Center, Greenwich, Connecticut.
Abstract
Background: Anorexia nervosa is highly prevalent among young women.
Objective: To determine prevalence and predictive factors for regional bone loss.
Design: Prospective cohort analysis.
Setting: University hospital.
Patients: 130 women with anorexia nervosa.
Measurements: Dual-energy x-ray absorptiometry.
Results: The prevalence of osteopenia (−1.0 SD ≥ T-score > −2.5 SD) and osteoporosis (T-score ≤ −2.5 SD) was 50% and 13% for the anterior–posterior spine, 57% and 24% for the lateral spine, and 47% and 16% for the total hip, respectively. Bone mineral density (BMD) was reduced by at least 1.0 SD at one or more skeletal sites in 92% of patients and by at least 2.5 SD in 38% of patients. Weight was the most consistent predictor of BMD at all skeletal sites. Twenty-three percent of patients were current estrogen users, and 58% were previous estrogen users. Bone mineral density did not differ by history of estrogen use at any site.
Conclusions: Bone mineral density is reduced at several skeletal sites in most women with anorexia nervosa. Weight, but not estrogen use, is a significant predictor of BMD in this population at all skeletal sites.
Article and Author Information
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Acknowledgments: The authors thank the nursing and bionutrition staffs of the General Clinical Research Center and Caryn Coyle, NP, for dedicated patient care and Judy Krempin, BA, for assistance in patient recruitment.
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Grant Support: In part by the National Institutes of Health (R01-DK52625, M01-RR01066, RO1-MH38333, and P32-DK07028), the Rubinstein Foundation, and the Harvard Eating Disorder Center.
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Requests for Single Reprints: Steven Grinspoon, MD, Neuroendocrine Unit, Bulfinch 457b, Massachusetts General Hospital, Boston, MA 02114.
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Current Author Addresses: Drs. Grinspoon, Miller, and Klibanski, Ms. Thomas, Ms. Pitts, and Ms. Gross: Neuroendocrine Unit, Bulfinch 457b, Massachusetts General Hospital, Boston, MA 02114.
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Dr. Mickley: Wilkins Center for Eating Disorders, 7 Riversville Road, Greenwich, CT 06831.
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Dr. Herzog: Eating Disorders Unit, Massachusetts General Hospital, Boston, MA 02114.
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Author Contributions: Conception and design: S. Grinspoon, D. Herzog, A. Klibanski.
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Analysis and interpretation of the data: S. Grinspoon, E. Thomas, S. Pitts, E. Gross, K. Miller, D. Herzog, A. Klibanski.
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Drafting of the article: S. Grinspoon, E. Thomas, S. Pitts, E. Gross, D. Mickley, A. Klibanski.
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Critical revision of the article for important intellectual content: S. Grinspoon, E. Thomas, S. Pitts, E. Gross, K. Miller, D. Herzog, A. Klibanski.
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Final approval of the article: S. Grinspoon, E. Thomas, S. Pitts, E. Gross, K. Miller, D. Herzog, A. Klibanski.
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Provision of study materials or patients: S. Grinspoon, E. Thomas, S. Pitts, E. Gross, D. Mickley, K. Miller, D. Herzog, A. Klibanski.
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Statistical expertise: S. Grinspoon, S. Pitts, E. Gross.
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Obtaining of funding: S. Grinspoon, D. Herzog, A. Klibanski.
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Collection and assembly of data: S. Grinspoon, E. Thomas, S. Pitts, K. Miller, D. Herzog, A. Klibanski.
- Copyright ©2004 by the American College of Physicians
