Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders--a nationwide register study.
OBJECTIVE
To study fracture risk in patients with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorders not otherwise specified (EDNOS).


METHODS
Cohort study including all Danes diagnosed with AN (n = 2,149), BN (n = 1,294), or EDNOS (n = 942) between 1977 and 1998. Each patient was compared with three randomly drawn age- and gender-matched control subjects.


RESULTS
Fracture risk was increased in AN after diagnosis compared to controls (incidence rate ratio: 1.98, 95% CI: 1.60-2.44), but not before. The increased fracture risk persisted more than 10 years after diagnosis. A significant increase in fracture risk was found before diagnosis in BN (1.31, 95% CI: 1.04-1.64), with a trend towards an increase after diagnosis (1.44, 95% CI: 0.93-2.22). EDNOS patients had a significant increase in fracture risk before (1.39, 95% CI: 1.06-1.81) and after diagnosis (1.77, 95% CI: 1.25-2.51).


CONCLUSIONS
The increased fracture risk many years after diagnosis indicates permanent skeletal damage.
Vestergaard
Peter
P
Department of Endocrinology and Metabolism C, Aarhus Amtssygehus, Aarhus University Hospital, Aarhus, Denmark. p-vest@post4.tele.dk
Emborg
Charlotte
C
Støving
René K
RK
Hagen
Claus
C
Mosekilde
Leif
L
Brixen
Kim
K
D000328:Adult; D000856:Anorexia Nervosa / Q000453:epidemiology*; D002032:Bulimia / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011897:Random Allocation; D012042:Registries