title: Follow-up of bone mineral density in 27 cases of anorexia nervosa.
abstract: Cortical and trabecular bone loss can lead to osteoporosis in chronic forms of anorexia nervosa (AN). As there is some debate about the reversibility of this condition, we performed a longitudinal follow-up study of 27 cases in which clinical, biological, X-ray and lumbar and femoral neck dual photon absorptiometry examinations were conducted every 6 months for up to 30 months. Three groups were distinguished: G1, untreated amenorrheic AN (N = 14, total follow-up 126 months); G2, effectively treated AN (N = 11, total follow-up 192 months), with two subgroups: fluoride (N = 5) and estrogen (N = 6); and G3, remitting AN with normalization of the gonadic function (N = 2, total follow-up 36 months). Results were adjusted for each patient to a 6-month variation. Semestrial variations in lumbar bone mineral density (BMD) were -2.1 +/- 1.3%, +2.8 +/- 1.5%, and -0.3 +/- 1.3% (mean +/- SEM), respectively for G1, G2 and G3; those for femoral neck BMD semestrial variations were -5.9 +/- 2.1%, -3.8 +/- 1.2% and -1.0 +/- 0.6%. Femoral neck and lumbar BMD variations for G1 were mainly correlated positively with bone-forming markers (serum osteocalcin, alkaline phosphatase) and negatively with initial lumbar BMD. Estrogen alone increased lumbar BMD by +1.4 +/- 2.3% every 6 months but did not stabilize femoral neck BMD (-3.5 +/- 1.4%). Fluoride increased lumbar BMD by 4.8 +/- 1.8%. Both lumbar and femoral neck BMD were stabilized in the remission group (-0.3 +/- 1.3% and -1.0 +/- 0.6%), despite half of the follow-up time with amenorrhea. In conclusion, untreated AN is associated with a marked trabecular and cortical bone loss (4-10% per year), which can lead to osteoporotic fractures. In prevention of bone loss, the efficacy of estrogen is difficult to investigate in AN, even with a well-controlled trial. Our study could provide argument that, when the observance of this preventive treatment is assessed, lumbar BMD can be stabilized in chronic forms of AN.
authors.affiliation: Department of Rheumatology, Nantes University Hospital Centre, France.
authors.forename: Y M
authors.initials: YM
authors.lastname: Maugars
authors.forename: J M
authors.initials: JM
authors.lastname: Berthelot
authors.forename: R
authors.initials: R
authors.lastname: Forestier
authors.forename: N
authors.initials: N
authors.lastname: Mammar
authors.forename: S
authors.initials: S
authors.lastname: Lalande
authors.forename: J L
authors.initials: JL
authors.lastname: Venisse
authors.forename: A M
authors.initials: AM
authors.lastname: Prost
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000188:drug therapy / Q000378:metabolism*; D015519:Bone Density / Q000187:drug effects; D002648:Child; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D005272:Femur Neck / Q000378:metabolism; D005459:Fluorides / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000378:metabolism
chemical_list: D004967:Estrogens; D005459:Fluorides