Bone turnover during inpatient nutritional therapy and outpatient follow-up in patients with anorexia nervosa compared with that in healthy control subjects.
BACKGROUND
Osteopenia and osteoporosis are among the most frequent and severe complications in adolescents with anorexia nervosa.


OBJECTIVE
The aim of this study was to assess the influence of nutritional therapy on bone metabolism during adolescent anorexia nervosa.


METHODS
We studied 19 anorectic patients aged 14.1 +/- 1.4 y (x +/- SD) with a body mass index (BMI; in kg/m(2)) of 14.2 +/- 1.4 and 19 age-matched control subjects aged 15.1 +/- 2.3 y with a BMI of 20.8 +/- 1.9 for 1 y. Blood samples were taken for the measurement of bone markers, insulin-like growth factor I (IGF-I), and leptin.


RESULTS
BMI rose significantly from 14.2 +/- 1.4 at baseline to 17.4 +/- 0.6 (P < 0.0001) at week 15. Compared with concentrations in the control subjects, concentrations of the bone formation markers procollagen type I propeptide (PICP) and bone alkaline phosphatase (bAP) in the anorectic patients were lower at baseline (PICP: P = 0.0071; bAP: P = 0.0012), increased with nutritional therapy (PICP: P = 0.0060, bAP: P = 0.0147), and were no longer significantly different (P > 0.05) during the follow-up period. Concentrations of IGF-I and leptin were significantly lower (P < 0.0001 for both) in the anorectic patients than in the control subjects at baseline. IGF-I increased with nutritional therapy but was still significantly lower (P = 0.0036) than that in the control group and decreased again during the follow-up period (P = 0.0126). In contrast, serum C-telopeptide decreased with nutritional therapy (P = 0.0446).


CONCLUSIONS
Nutritional therapy improves concentrations of bone formation markers in adolescent patients with anorexia nervosa.
DLR-Institute of Aerospace Medicine, Space Physiology, Linder Hoehe, 51170 Cologne, Germany. martina.heer@dlr.de
Martina
M
Heer
Claudia
C
Mika
Ina
I
Grzella
Nicole
N
Heussen
Beate
B
Herpertz-Dahlmann
D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena; D000469:Alkaline Phosphatase / Q000097:blood; D000856:Anorexia Nervosa / Q000097:blood / Q000178:diet therapy* / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D001842:Bone and Bones / Q000378:metabolism*; D016022:Case-Control Studies; D024042:Collagen Type I / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D020738:Leptin / Q000097:blood*; D044623:Nutrition Therapy; D009752:Nutritional Status; D010012:Osteogenesis; D016896:Treatment Outcome
D015415:Biomarkers; D024042:Collagen Type I; D020738:Leptin; D007334:Insulin-Like Growth Factor I; D000469:Alkaline Phosphatase