help button home button Endocrine Society JCEM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Soyka, L. A.
Right arrow Articles by Klibanski, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Soyka, L. A.
Right arrow Articles by Klibanski, A.
The Journal of Clinical Endocrinology & Metabolism Vol. 84, No. 12 4489-4496
Copyright © 1999 by The Endocrine Society

From the Clinical Research Centers

The Effects of Anorexia Nervosa on Bone Metabolism in Female Adolescents1

Leslie A. Soyka, Steven Grinspoon, Lynne L. Levitsky, David B. Herzog and Anne Klibanski

Neuroendocrine Unit (L.A.S., S.G., A.K.), Pediatric Endocrine Unit (L.A.S., L.L.L.), and Eating Disorders Unit (D.B.H.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114

Address all correspondence and requests for reprints to: Dr. Anne Klibanski, Neuroendocrine Unit, Bulfinch 457, Massachusetts General Hospital, Boston, Massachusetts 02114.

Osteopenia is a frequent, often persistent, complication of anorexia nervosa (AN) in adolescent girls and occurs during a critical time in bone development. Little is known about bone metabolism in this patient population. Therefore, we measured bone density (BMD) and body composition by dual energy x-ray absorptiometry, nutritional status, bone turnover, calcium, and hormonal status in 19 adolescent girls with AN (mean ± SEM, 16.0 ± 0.4 yr) and 19 bone age-matched controls. The mean duration of AN was 19 ± 5 months. Spinal (L1–L4) osteopenia was common in AN. Lumbar anterioposterior BMD was more than 1 SD below the mean in 42% of patients, and lateral spine BMD was more than 1 SD below in 63% of patients compared with controls. Lean body mass significantly predicted lumbar bone mineral content (r = 0.75; P < 0.0001) in controls only. In AN, duration of illness was the most significant predictor of spinal BMD (lumbar: r = -0.44; P = 0.06; lateral: r = -0.59; P = 0.008). AN adolescents with mature BA (15 yr and greater) were hypogonadal [estradiol, 16.2 ± 1.9 vs. 23.3 ± 1.6 pg/mL (P = 0.01); free testosterone, 0.70 ± 0.17 vs. 1.36 ± 0.14 pg/mL (P = 0.01)] although dehydroepiandrosterone sulfate and urinary free cortisol levels did not differ. Leptin levels were reduced in AN (2.9 ± 2.1 vs. 16.5 ± 1.8 ng/mL; P < 0.0001). Insulin-like growth factor I (IGF-I) was reduced in AN to 50% of control levels (219 ± 41 vs. 511 ± 35 ng/mL; P < 0.0001) and correlated with all measures of nutritional status, particularly leptin (r = 0.80; P < 0.0001). Surrogate markers of bone formation, serum osteocalcin (OC) and bone-specific alkaline phosphatase (BSAP), were significantly (P = 0.02) reduced in AN vs. controls (OC, 39.1 ± 6.4 vs. 59.2 ± 5.2 ng/mL; BSAP, 27.9 ± 4.0 vs. 40.6 ± 3.4 U/L). The majority of the variation in bone formation in AN was due to IGF-I levels (OC: r2 = 0.72; P = 0.002; BSAP: r2 = 0.53; P = 0.01) in stepwise regression analyses. Bone resorption was comparable in patients and controls. These data demonstrate that bone formation is reduced and uncoupled to bone resorption in mature adolescents with AN in association with low bone density. Lean body mass was a significant predictor of BMD in controls, but not AN patients. The major correlate of bone formation in AN was the nutritionally dependent bone trophic factor, IGF-I. Reduced IGF-I during the critical period of bone mineral accumulation may be an important factor in the development of osteopenia in adolescents with AN.




This article has been cited by other articles:


Home page
 J EndocrinolHome page
R Hardy and M S Cooper
Bone loss in inflammatory disorders
J. Endocrinol., June 1, 2009; 201(3): 309 - 320.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
A. D. DiVasta, H. A. Feldman, A. E. Quach, M. Balestrino, and C. M. Gordon
The Effect of Bed Rest on Bone Turnover in Young Women Hospitalized for Anorexia Nervosa: A Pilot Study
J. Clin. Endocrinol. Metab., May 1, 2009; 94(5): 1650 - 1655.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
E. A. Lawson, M. Misra, E. Meenaghan, L. Rosenblum, D. A. Donoho, D. Herzog, A. Klibanski, and K. K. Miller
Adrenal Glucocorticoid and Androgen Precursor Dissociation in Anorexia Nervosa
J. Clin. Endocrinol. Metab., April 1, 2009; 94(4): 1367 - 1371.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
M. A. Goldstein, D. B. Herzog, M. Misra, and P. Sagar
Case 29-2008 -- A 19-Year-Old Man with Weight Loss and Abdominal Pain
N. Engl. J. Med., September 18, 2008; 359(12): 1272 - 1283.
[Full Text] [PDF]

Home page
 IBMS BoneKEyHome page
M. L. Bianchi
Diagnosis and Treatment of Bone Fragility in Childhood
IBMS BoneKEy, September 1, 2008; 5(9): 323 - 335.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
M. Misra, D. K. Katzman, J. Cord, S. J. Manning, N. Mendes, D. B. Herzog, K. K. Miller, and A. Klibanski
Bone Metabolism in Adolescent Boys with Anorexia Nervosa
J. Clin. Endocrinol. Metab., August 1, 2008; 93(8): 3029 - 3036.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
M. Misra, R. Prabhakaran, K. K. Miller, M. A. Goldstein, D. Mickley, L. Clauss, P. Lockhart, J. Cord, D. B. Herzog, D. K. Katzman, et al.
Prognostic Indicators of Changes in Bone Density Measures in Adolescent Girls with Anorexia Nervosa-II
J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1292 - 1297.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
B. Galusca, M. Zouch, N. Germain, C. Bossu, D. Frere, F. Lang, M.-H. Lafage-Proust, T. Thomas, L. Vico, and B. Estour
Constitutional Thinness: Unusual Human Phenotype of Low Bone Quality
J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 110 - 117.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
J. Dominguez, L. Goodman, S. Sen Gupta, L. Mayer, S. F. Etu, B T. Walsh, J. Wang, R. Pierson, and M. P Warren
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
Am. J. Clinical Nutrition, July 1, 2007; 86(1): 92 - 99.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
K. K. Miller, E. A. Lawson, V. Mathur, T. L. Wexler, E. Meenaghan, M. Misra, D. B. Herzog, and A. Klibanski
Androgens in Women with Anorexia Nervosa and Normal-Weight Women with Hypothalamic Amenorrhea
J. Clin. Endocrinol. Metab., April 1, 2007; 92(4): 1334 - 1339.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
M. Misra, P. Tsai, E. J Anderson, J. L Hubbard, K. Gallagher, L. A Soyka, K. K Miller, D. B Herzog, and A. Klibanski
Nutrient intake in community-dwelling adolescent girls with anorexia nervosa and in healthy adolescents.
Am. J. Clinical Nutrition, October 1, 2006; 84(4): 698 - 706.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
K. J. Loud and C. M. Gordon
Adolescent bone health.
Arch Pediatr Adolesc Med, October 1, 2006; 160(10): 1026 - 1032.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
K. K. Miller, E. E. Lee, E. A. Lawson, M. Misra, J. Minihan, S. K. Grinspoon, S. Gleysteen, D. Mickley, D. Herzog, and A. Klibanski
Determinants of Skeletal Loss and Recovery in Anorexia Nervosa
J. Clin. Endocrinol. Metab., August 1, 2006; 91(8): 2931 - 2937.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
M. Misra, K. K. Miller, V. Stewart, E. Hunter, K. Kuo, D. B. Herzog, and A. Klibanski
Ghrelin and Bone Metabolism in Adolescent Girls with Anorexia Nervosa and Healthy Adolescents
J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5082 - 5087.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
K. K. Miller, K. A. Grieco, and A. Klibanski
Testosterone Administration in Women with Anorexia Nervosa
J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1428 - 1433.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. Misra, A. Aggarwal, K. K. Miller, C. Almazan, M. Worley, L. A. Soyka, D. B. Herzog, and A. Klibanski
Effects of Anorexia Nervosa on Clinical, Hematologic, Biochemical, and Bone Density Parameters in Community-Dwelling Adolescent Girls
Pediatrics, December 1, 2004; 114(6): 1574 - 1583.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
M. Misra, K. K. Miller, C. Almazan, K. Ramaswamy, W. Lapcharoensap, M. Worley, G. Neubauer, D. B. Herzog, and A. Klibanski
Alterations in Cortisol Secretory Dynamics in Adolescent Girls with Anorexia Nervosa and Effects on Bone Metabolism
J. Clin. Endocrinol. Metab., October 1, 2004; 89(10): 4972 - 4980.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
M. Cifuentes, C. S Riedt, R. E Brolin, M P. Field, R. M Sherrell, and S. A Shapses
Weight loss and calcium intake influence calcium absorption in overweight postmenopausal women
Am. J. Clinical Nutrition, July 1, 2004; 80(1): 123 - 130.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
M. Misra, K. K. Miller, C. Almazan, K. Ramaswamy, A. Aggarwal, D. B. Herzog, G. Neubauer, J. Breu, and A. Klibanski
Hormonal and Body Composition Predictors of Soluble Leptin Receptor, Leptin, and Free Leptin Index in Adolescent Girls with Anorexia Nervosa and Controls and Relation to Insulin Sensitivity
J. Clin. Endocrinol. Metab., July 1, 2004; 89(7): 3486 - 3495.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
M. Misra, K. K. Miller, J. Bjornson, A. Hackman, A. Aggarwal, J. Chung, M. Ott, D. B. Herzog, M. L. Johnson, and A. Klibanski
Alterations in Growth Hormone Secretory Dynamics in Adolescent Girls with Anorexia Nervosa and Effects on Bone Metabolism
J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5615 - 5623.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
M. Misra, L. A. Soyka, K. K. Miller, D. B. Herzog, S. Grinspoon, D. de Chen, G. Neubauer, and A. Klibanski
Serum Osteoprotegerin in Adolescent Girls with Anorexia Nervosa
J. Clin. Endocrinol. Metab., August 1, 2003; 88(8): 3816 - 3822.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
M. Misra, L. A Soyka, K. K Miller, S. Grinspoon, L. L Levitsky, and A. Klibanski
Regional body composition in adolescents with anorexia nervosa and changes with weight recovery
Am. J. Clinical Nutrition, June 1, 2003; 77(6): 1361 - 1367.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
J. N. Roemmich, P. A. Clark, C. S. Mantzoros, C. M. Gurgol, A. Weltman, and A. D. Rogol
Relationship of Leptin to Bone Mineralization in Children and Adolescents
J. Clin. Endocrinol. Metab., February 1, 2003; 88(2): 599 - 604.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
C. M. Gordon, E. Grace, S. J. Emans, H. A. Feldman, E. Goodman, K. A. Becker, C. J. Rosen, C. M. Gundberg, and M. S. LeBoff
Effects of Oral Dehydroepiandrosterone on Bone Density in Young Women with Anorexia Nervosa: A Randomized Trial
J. Clin. Endocrinol. Metab., November 1, 2002; 87(11): 4935 - 4941.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
L. A. Soyka, M. Misra, A. Frenchman, K. K. Miller, S. Grinspoon, D. A. Schoenfeld, and A. Klibanski
Abnormal Bone Mineral Accrual in Adolescent Girls with Anorexia Nervosa
J. Clin. Endocrinol. Metab., September 1, 2002; 87(9): 4177 - 4185.
[Abstract] [Full Text] [PDF]

Home page
 Endocr. Rev.Home page
M. Peacock, C. H. Turner, M. J. Econs, and T. Foroud
Genetics of Osteoporosis
Endocr. Rev., June 1, 2002; 23(3): 303 - 326.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
K. K. Miller, B. M. K. Biller, J. Hier, E. Arena, and A. Klibanski
Androgens and Bone Density in Women with Hypopituitarism
J. Clin. Endocrinol. Metab., June 1, 2002; 87(6): 2770 - 2776.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
S. Grinspoon, L. Thomas, K. Miller, D. Herzog, and A. Klibanski
Effects of Recombinant Human IGF-I and Oral Contraceptive Administration on Bone Density in Anorexia Nervosa
J. Clin. Endocrinol. Metab., June 1, 2002; 87(6): 2883 - 2891.
[Abstract] [Full Text] [PDF]

Home page
 Br. J. Sports. Med.Home page
K M Khan, T Liu-Ambrose, M M Sran, M C Ashe, M G Donaldson, J D Wark, and A Nattiv
New criteria for female athlete triad syndrome?
Br. J. Sports Med., February 1, 2002; 36(1): 10 - 13.
[Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
P. S. Mehler
Diagnosis and Care of Patients with Anorexia Nervosa in Primary Care Settings
Ann Intern Med, June 5, 2001; 134(11): 1048 - 1059.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
W. P. Fairfield, J. S. Finkelstein, A. Klibanski, and S. K. Grinspoon
Osteopenia in Eugonadal Men with Acquired Immune Deficiency Syndrome Wasting Syndrome
J. Clin. Endocrinol. Metab., May 1, 2001; 86(5): 2020 - 2026.
[Abstract] [Full Text]

Home page
 J. Clin. Endocrinol. Metab.Home page
C. J. Rosen and J. P. Bilezikian
Anabolic Therapy for Osteoporosis
J. Clin. Endocrinol. Metab., March 1, 2001; 86(3): 957 - 964.
[Abstract] [Full Text]

Home page
 ANN INTERN MEDHome page
S. Grinspoon, E. Thomas, S. Pitts, E. Gross, D. Mickley, K. Miller, D. Herzog, and A. Klibanski
Prevalence and Predictive Factors for Regional Osteopenia in Women with Anorexia Nervosa
Ann Intern Med, November 21, 2000; 133(10): 790 - 794.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
G. R. Mundy
Secondary Osteoporosis: The Potential Relevance of Leptin and Low Body Weight
Ann Intern Med, November 21, 2000; 133(10): 828 - 830.
[Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
L. A. Soyka, W. P. Fairfield, and A. Klibanski
Hormonal Determinants and Disorders of Peak Bone Mass in Children
J. Clin. Endocrinol. Metab., November 1, 2000; 85(11): 3951 - 3963.
[Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Endocrinology Endocrine Reviews J. Clin. End. & Metab.
Molecular Endocrinology Recent Prog. Horm. Res. All Endocrine Journals
Copyright © 1999 by The Endocrine Society