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This version published online on December 18, 2007
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2007-2419
A more recent version of this article appeared on April 1, 2008
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Submitted on October 31, 2007
Accepted on December 7, 2007

Prognostic Indicators of Changes in Bone Density Measures in Adolescent Girls with Anorexia Nervosa-II

Madhusmita Misra*, Rajani Prabhakaran, Karen K. Miller, Mark A. Goldstein, Diane Mickley, Laura Clauss, Patrice Lockhart, Jennalee Cord, David B. Herzog, Debra K. Katzman, and Anne Klibanski

Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA, Pediatric Endocrine Unit, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA, USA; Adolescent Medicine Unit, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA, USA, Wilkins Center for Eating Disorders, Greenwich, CT, USA, Bedford Center for Eating Disorders, Bedford, NH, USA; Eating Disorders Center, Mercy Hospital, Portland, ME, USA; Harris Center, Massachusetts General Hospital, Boston, MA, USA, Division of Adolescent Medicine, Department of Paediatrics, Hospital for Sick Kids, Toronto, Canada

* To whom correspondence should be addressed. E-mail: mmisra{at}partners.org.

Introduction: Adolescents with anorexia nervosa (AN) have low bone mineral density (BMD). Baseline predictors of temporal BMD changes ({Delta}BMD) in AN, including (i) gastrointestinal peptides regulating food intake and appetite that have been related to bone metabolism, and (ii) bone turnover markers, have not been well characterized. We hypothesized that baseline levels of nutritionally regulated hormones and of bone turnover markers would predict {Delta}BMD overall.

Methods: In a prospective observational study, lumbar and whole body (WB) BMD were measured at 0, 6 and 12 months in 34 AN girls 12–18 yo and 33 controls. Baseline BMI, lean mass, nutritionally regulated hormones [IGF-1, cortisol, ghrelin, leptin, peptide YY (PYY)], bone formation and resorption markers were examined to determine nutritional and hormonal predictors of bone density changes.

Results: In a regression model, baseline ghrelin and PYY predicted changes in spine bone measures, and baseline ghrelin, cortisol and PYY predicted changes in WB bone measures independent of baseline nutritional status.

Conclusions: Neuroendocrine gastrointestinal derived peptides regulating food intake are independent predictors of changes in bone mass in AN.
Key words: Anorexia nervosa • adolescents • bone density • bone turnover markers • ghrelin • cortisol • IGF-I • peptide YY




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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.
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