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Weight Gain and Restoration of Menses as Predictors of Bone Mineral Density Change in Adolescent Girls with Anorexia Nervosa-1

Neuroendocrine Unit (M.M., R.P., K.K.M., J.C., A.K.), Massachusetts General Hospital and Harvard Medical School, Pediatric Endocrine Unit (M.M., R.P.) and Adolescent Medicine Unit (M.A.G.), Massachusetts General Hospital for Children and Harvard Medical School, and Harris Center (D.B.H.), Massachusetts General Hospital, Boston, Massachusetts 02114; Wilkins Center for Eating Disorders (D.M.), Greenwich, Connecticut 06831; Bedford Center for Eating Disorders (L.C.), Bedford, New Hampshire 03110; Eating Disorders Center (P.L.), Mercy Hospital, Portland, Maine 04101; and Division of Adolescent Medicine (D.K.K.), Department of Pediatrics, Hospital for Sick Children, Toronto, Canada M5G 1X8

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

Context: Adolescents with anorexia nervosa (AN) have low bone mineral density. However, the effect of disease recovery, first, on bone density measures assessed using the Molgaard approach, which differentiates between reported low bone density resulting from short bones (based on height Z-scores) and that resulting from thin bones [based on measures of bone area (BA) for height] or light bones [based on measures of bone mineral content (BMC) for BA]; and second, on height-adjusted bone density measures, has not been well characterized. We hypothesized that menstrual recovery and weight gain (10% increase in body mass index) would predict an increase in these measures of bone density.

Methods: In a prospective observational study, lumbar and whole-body (WB) bone density was measured at 0, 6, and 12 months in 34 AN girls aged 12–18 yr and 33 controls. Using Ward’s modification of the Molgaard approach, we determined measures of BMC for BA and BA for height at the lumbar spine and WB and also determined spine bone mineral apparent density and WB BMC adjusted for height.

Results: Girls with AN had lower spine BMC for BA Z-scores (P = 0.0009), and lower WB BA for height Z (P < 0.0001), compared with controls. Menstrual recovery and weight gain in AN (AN-recovered) (median 9 months) resulted in a stabilization of BMD measures, whereas BMD continued to decrease in AN who did not gain weight and recover menses (AN-not recovered). AN-recovered also predicted greater increases in spine BMC for BA and WB BA for height, compared with AN-not recovered (P < 0.05).

Conclusions: Even short-term weight gain with menstrual recovery is associated with a stabilization of BMD measures.

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				R. L. Prince and K. Zhu Whole-Body Dual-Energy X-Ray Absorptiometry Comes of Age: Bone Structural Measures and Their Physiological Determinants in Anorexia Nervosa J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1178 - 1180. [Full Text] [PDF]

				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]