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Relationships between Serum Adipokines, Insulin Levels, and Bone Density in Girls with Anorexia Nervosa

Neuroendocrine Unit (M.M., K.K.M., J.C., R.P., A.K.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; Harris Center (D.B.H.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Adolescent Medicine (M.G.), MassGeneral Hospital for Children and Harvard Medical School, Boston, Massachusetts 02114; and Division of Adolescent Medicine (D.K.K.), Department of Pediatrics, Hospital for Sick Kids, Toronto, Canada M5G 1X8

Address all correspondence and requests for reprints to: Madhusmita Misra, M.D., BUL 457, Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114. E-mail: mmisra{at}partners.org.

Background: Adolescents with anorexia nervosa (AN) have low bone mineral density (BMD). Adipokines and insulin play an important role in bone metabolism in healthy individuals. However, their association with bone metabolism in AN is unknown.

Objective: The aim of the study was to determine whether adipokines and insulin are independently associated with measures of BMD in adolescents with AN and controls.

Design/Methods: Levels of adiponectin and insulin, fasting and after oral glucose, were evaluated in 17 AN patients and 19 controls (age, 12–18 yr), in whom hormonal parameters [GH, IGF-I, cortisol, estradiol, leptin, ghrelin, and peptide YY (PYY)] had been previously determined. Body composition, bone mineral content, and BMD at the lumbar spine, hip, femoral neck, and total body were assessed by dual energy x-ray absorptiometry. Two bone formation and bone resorption markers were examined.

Setting: The study was conducted at a General Clinical Research Center.

Results: Adiponectin differed between AN subjects and controls after controlling for fat mass and decreased in both after oral glucose (P = 0.02 and 0.07). On regression modeling, independent associations were observed of: 1) body mass index and adiponectin with lumbar spine bone mineral apparent density Z-scores (r² = 0.45); 2) lean mass, PYY, and ghrelin with hip Z-scores (r² = 0.55); 3) adiponectin and lean mass with femoral neck-bone mineral apparent density Z-scores (r² = 0.34); and 4) lean mass, PYY, GH, and ghrelin with total body-bone mineral content/height Z-scores (r² = 0.64), for the combined group. Adiponectin was also independently associated with BMD, and insulin was associated with bone turnover markers in the groups considered separately.

Conclusions: Adiponectin contributes significantly to the variability of bone density, and insulin contributes to bone turnover markers in adolescent girls.

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