Impact of Eating Disorders on Bone Health in Young Patients

Overview of Eating Disorders

Eating disorders are a growing concern in the United States, impacting approximately 30 million individuals. These disorders not only affect mental health but also have significant physical implications. The physical health challenges associated with eating disorders can lead to severe and potentially irreversible consequences. While many of these effects can be mitigated with the restoration of normal weight and eating behaviors, some long-term complications persist.

Bone Disease as a Long-Term Complication

One notable complication associated with eating disorders is an increased risk of bone disease, which appears to have lasting effects. Malnutrition resulting from anorexia can lead to fragile bones, making fractures more likely. This condition can result in permanent disability among young patients suffering from eating disorders. Despite the recognized correlation between these disorders and bone disease, the underlying causes and treatment options for adults remain largely unexplored.

Research Findings on Bone Disease and Eating Disorders

Study Overview by Anne Drabkin and Colleagues

A recent study led by Anne Drabkin and her team aimed to collate existing research to enhance understanding of the relationship between eating disorders and bone disease. Their findings, published in the Journal of Eating Disorders, involved a thorough literature review of studies from 1996 to 2016. Keywords such as “anorexia nervosa” and “bone density” were utilized to select relevant papers based on various criteria.

Key Findings on Bone Disease

The review consistently highlighted an increased incidence of bone disease among individuals with eating disorders. The investigators noted that the causes are complex and still under investigation. Some patients may have pre-existing vulnerabilities to bone disease, and it was found that lower body mass index (BMI) correlates with increased risk. Additional factors contributing to secondary bone disease included premenopausal amenorrhea, Cushing’s syndrome, celiac disease, liver disease, low testosterone levels, hyperthyroidism, rheumatoid arthritis, lupus, certain medications, diabetes, vitamin D deficiency, smoking, and alcohol use.

Treatment Approaches for Bone Disease in Eating Disorder Patients

Initial Treatment Strategies

The primary approach to managing bone disease in patients with eating disorders involves weight restoration and the normalization of menstrual cycles in females. Adequate intake of vitamin D and calcium is also essential. It is crucial that any weight-bearing exercises are conducted under professional supervision to ensure safety and promote weight gain.

Pharmacological Considerations

Healthcare providers may consider administering estrogen and progesterone to patients at risk of fractures or experiencing ongoing bone density decline. Other medications, such as denosumab and testosterone for men, have not yet been rigorously tested in this population but can be trialed when appropriate. The persistent nature of bone disease raises questions about the use of pharmacological treatments, which should be tailored to individual patient needs while considering cost and administration challenges.

Need for Further Research

Currently, there are no standardized treatment guidelines for patients with eating disorders who are experiencing bone disease. The primary focus remains on weight restoration, with recommendations for screening patients for other potential causes of bone disease. Ongoing research is essential to address the specific needs of this vulnerable group and to develop strategies that can prevent lasting deformities that may impact their lives significantly.

Reference

Drabkin, A., Rothman, M.S., Wassenaar, E., Mascolo, M., Mehler, P.S. (2017). Assessment and clinical management of bone disease in adults with eating disorders: a review. J Eat Disord. doi: 10.1186/s40337-017-0172-0