title: Dissociation of bone turnover in anorexia nervosa.
abstract: Biochemical markers were measured to assess bone turnover in a cross-sectional study of 43 patients with anorexia nervosa; 28 were at their first assessment (untreated) with a body mass index (BMI) (median interquartile range) of 13.3 (2) kg/m2. A second group of 15 patients undergoing treatment (treated) had a median BMI of 17.6 (2.8) kg/m2. The median, interquartile range of urinary deoxypyridinoline (DPyd), a bone resorption marker, was raised in both groups compared with an age-matched control population [DPyd = 17.8 (15.2), 17.5 (16.4) and 9.2 (4.0) nmol/mmol creatinine, respectively]. Serum type 1 collagen carboxyterminal propeptide (P1CP), a marker of bone formation, was similar to controls in the untreated patients [112 (29) and 112 (78.5) ng/ml, respectively], but was significantly raised in the treated patients [163 (219) ng/ml, P < 0.05]. A second group of 21 patients was followed prospectively, on admission and during 8 weeks of intensive inpatient care (BMI on admission and after 8 weeks was 13.0 (2) and 16.7 (3) kg/m2, respectively). The resorption marker, serum type 1 collagen carboxyterminal telopeptide (1CTP) was raised on admission and remained high during treatment. P1CP and osteocalcin levels were similar to control levels on admission but increased with treatment, and after 8 weeks were 40% and 63% higher respectively than on admission. These findings suggest that in untreated anorexia nervosa there was uncoupling of bone turnover as bone resorption markers were raised without a concomitant increase in bone formation markers. As the condition was treated and patients gained weight, the formation markers also increased, leading to a more balanced, although higher, bone turnover.
authors.affiliation: Department of Clinical Biochemistry, King's College Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Stefanis
authors.forename: C
authors.initials: C
authors.lastname: Mackintosh
authors.forename: H D
authors.initials: HD
authors.lastname: Abraha
authors.forename: J
authors.initials: J
authors.lastname: Treasure
authors.forename: C
authors.initials: C
authors.lastname: Moniz
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood / Q000652:urine; D000596:Amino Acids / Q000652:urine; D000856:Anorexia Nervosa / Q000097:blood / Q000503:physiopathology* / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015992:Body Mass Index; D001862:Bone Resorption; D002118:Calcium / Q000097:blood / Q000652:urine; D003094:Collagen / Q000097:blood / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D015675:Osteocalcin / Q000097:blood / Q000652:urine; D011446:Prospective Studies
chemical_list: D000596:Amino Acids; D015415:Biomarkers; D015675:Osteocalcin; C036020:deoxypyridinoline; D003094:Collagen; D000469:Alkaline Phosphatase; D002118:Calcium