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This version published online on October 23, 2007
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2007-1591
A more recent version of this article appeared on January 1, 2008
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Right arrow Calcium and Bone Metabolism

Submitted on July 17, 2007
Accepted on October 12, 2007

Constitutional Thinness: Unusual Human Phenotype of Low Bone Quality

Bogdan Galusca, Mohamed Zouch, Natacha Germain, Cecile Bossu, Delphine Frere, Francois Lang, Marie-Helene Lafage-Proust, Thierry Thomas, Laurence Vico, and Bruno Estour*

Endocrinology Department, CHU Saint Etienne, France; INSERM U890, Saint Etienne, France; Nuclear Medicine Laboratory, CHU Saint Etienne, France; Psychiatry Department, CHU Saint Etienne, France; and Endocrinology Department, UMF Iasi, Romania

* To whom correspondence should be addressed. E-mail: bruno.estour{at}chu-st-etienne.fr.

Context. Low fat mass, and hormonal or nutritional deficiencies are often incriminated in bone loss related to thinness. Constitutional thinness (CT) has been described in young women with low BMI but close-to-normal body composition, physiological menstruation, no hormonal abnormalities and no anorexia nervosa (AN) psychological profile.

Objective. To determine whether CT is associated with impaired bone quality.

Design, Setting, and Participants. Observational, cross-sectional study on 25 CT and 44 AN young women with similar low BMI (< 16.5 kg/m2) and 28 age-matched controls.

Main Outcome Measures. Femoral and lumbar spine bone mineral density (BMD) by DXA; distal tibia and radius bone architecture and breaking strength by 3D-pQCT; bone turnover markers.

Results. CT subjects displayed a higher percentage of fat mass than AN subjects, but had similar lumbar and femoral BMD, which were significantly lower than in controls (P< 0.001). CT subjects displayed more markedly impaired trabecular and cortical bone parameters in the distal tibia than in the radius. AN bone structure was impaired only in subjects with a long history of disease. Calculated breaking strength was decreased in CT and longstanding AN in both the radius and the tibia. Bone markers in CT subjects were similar to those of controls. OPG/RANKL ratio was higher in CT subjects than in controls or AN women.

Conclusions. Young women with CT present an unexpectedly high prevalence of low bone mass (44%) associated with small bone size, overall diminished breaking strength but normal bone turnover. Mechanisms related to insufficient skeletal load and/or genetics are proposed to explain this new phenotype of impaired bone quality.
Key words: constitutional thinness • anorexia nervosa • bone mineral density • bone architecture • breaking strength






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